Extended outpatient chemoprophylaxis reduces venous thromboembolism after radical cystectomy

Schomburg, John; Krishna, Suprita; Soubra, Ayman; Cotter, Katherine; Fan, Yunshan; Brown, Graham V.; Konety, Badrinath R.

doi:10.1016/j.urolonc.2017.09.029

Cited by 27 publications

(24 citation statements)

References 22 publications

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“…It is well established that the VTE risk after RC is lower for patients on ETP compared to STP, and studies directly comparing VTE risk in ETP vs STP all showed this ( n = 3) . Although the follow‐up periods and definition of ETP varied, a lower VTE incidence was reported for patients on ETP, with VTE risk reported as 5.06% compared to 17.6% (90‐day follow‐up) , 2% compared to 6% (90‐day follow‐up) , and 11% compared to 23% (365‐day follow‐up) . Kukreja et al.…”

Section: Resultsmentioning

confidence: 96%

“…1. A summary of the literature and results can be found in Table 1 [ [5,6,10,11,[14][15][16][17][18][19][20][21][22][23][24][25][26][27]].…”

Section: Literature Searchmentioning

confidence: 99%

“…The incidence of VTE after urological cancer surgery is well documented. A total of 12 studies provided data on VTE incidence for a single procedure type [5,11,[14][15][16][17][18][19][20][21][22]. The other papers reviewed commented on VTE risks for urological cancer operations in general that included multiple procedures.…”

Section: Vte Incidencementioning

confidence: 99%

“…RC is the only procedure for which direct comparisons of bleeding risk in ETP vs STP have been made [14,23]. Two studies reported a higher risk of bleeding for patients on ETP compared to STP, at 10% compared to 7% [6] and 49% compared to 44% [23], although both of these differences were not statistically significant.…”

Section: Morbidity Bleedingmentioning

confidence: 99%

“…Evidence currently suggests RC confers the highest incidence of VTE [5,11,17]. ETP was reported to produce a significant reduction in VTE incidence for RC compared with STP [6,14,23]. Moreover, when dividing RC into different approaches, including open RC and RARC, ETP still produced a noticeable reduction in VTE incidence [6].…”

Section: Rcmentioning

confidence: 99%

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The role of extended venous thromboembolism prophylaxis for major urological cancer operations

et al. 2019

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Rishi Naik and Indrajeet Mandal are joint first authors. ObjectivesVenous thromboembolism (VTE), consisting of both pulmonary embolism (PE) and deep vein thromboses (DVT), remains a well-recognised complication of major urological cancer surgery. Several international guidelines recommend extended thromboprophylaxis (ETP) with LMWH, whereby the period of delivery is extended to the post-discharge period, where the majority of VTE occurs. In this literature review we investigate whether ETP should be indicated for all patients undergoing major urological cancer surgery, as well procedure specific data that may influence a clinician's decision. MethodsWe performed a search of six databases (PubMed, Cochrane, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and British Nursing Index (BNI)) from inception to June 2019, for studies looking at adult patients who received VTE prophylaxis after surgery for a major urological malignancy. ResultsEighteen studies were analysed. VTE risk is highest in open and robotic Radical Cystectomy (RC) (2.6-11.6%) and ETP demonstrates a significant reduction in risk of VTE, but not a significant difference in Pulmonary Embolism (PE) or mortality. Risk of VTE in open Radical Prostatectomy (RP) (0.8-15.7%) is comparable to RC, but robotic RP (0.2-0.9%), open partial/radical nephrectomy (1.0-4.4%) and robotic partial/radical nephrectomy (0.7-3.9%) were lower risk. It has not been shown that ETP reduces VTE risk specifically for RP or nephrectomy. ConclusionThe decision to use ETP is a fine balance between variables such as VTE incidence, bleeding risk and perioperative morbidity/mortality. This balance should be assessed for each specific procedure type. While ETP still remains of net benefit for open RP as well as open and robotic RC, the balance is closer for minimally invasive RP as well as radical and partial nephrectomy. Due to a lack of procedure specific evidence for the use of ETP, adherence with national guidelines remains poor. Therefore, we advocate further studies directly comparing ETP vs standard prophylaxis, for specific procedure types, in order to allow clinicians to make a more informed decision in future.

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Section: Resultsmentioning

confidence: 96%