Prevention of postoperative deep-vein thrombosis by low-dose heparin in open prostatectomy

Vandendris, Michel; Kutnowski, M; Futeral, Bernard; Gianakopoulos, X; Kraytman, M; Grégoir, W

doi:10.1007/bf00256997

Cited by 28 publications

(9 citation statements)

References 13 publications

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“…The incidence of symptomatic DVT after major urologic surgery has decreased from 15-40% as reported up to 30 years ago [4,5] to more contemporary rates of 1-5% [6][7][8] with the introduction of pharmacological prophylaxis, early mobilization and the use of sequential mechanical compression devices. With respect to laparoscopic or robotic-assisted laparoscopic radical prostatectomy (RALP), Secin et al [9] reported a 0.5% incidence of venous thromboemobolism (VTE) in a large retrospective review of 5951 patients.…”

Section: Introductionmentioning

confidence: 99%

Heparin prophylaxis and the risk of venous thromboembolism after robotic‐assisted laparoscopic prostatectomy

Patel¹,

Kirby

Hruby

et al. 2011

BJU International

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Study Type – Therapy (case series)Level of Evidence 4What’s known on the subject? and What does the study add?The incidence of deep venous thrombosis (DVT) in major urological surgery has decreased over time with the introduction of pharmacological prophylaxis, early mobilization, and the use of sequential mechanical compression devices. We examined the value of heparin prophylaxis in robotic assisted laparoscopic prostatectomy (RALP), where the risk of DVT is already low.The rate of thromboemolic events within 30 days was 0.6% in this series. Heparin did not influence estimated blood loss, haematrocrit change, or length of stay. The incidence of thromboembolism is low after RALP, which may obviate the use of heparin prophylaxis. However, its use appears to be safe and does not affect surgical outcomes.OBJECTIVE• The incidence of venous thromboembolism (VTE) after robotic‐assisted laparoscopic prostatectomy (RALP) in patients receiving perioperative heparin prophylaxis was compared with those who did not receive such prophylaxis.MATERIALS AND METHODS• Between July 2007 to February 2010, a total of 307 RALPs were performed at our institution by two surgeons. A total of 187 patients operated on by surgeon 1 received perioperative heparin prophylaxis, whereas 120 patients operated on by surgeon 2 did not receive any.• All demographic, clinical and pathological data were prospectively recorded, whereas the incidence of venous thromboembolism within 30 days of the operation was retrospectively reviewed. Evaluation for potential VTE was based on clinical symptoms.RESULTS• Cohorts were comparable with respect to PSA, clinical stage, preoperative Gleason score, body mass index, smoking status, pathological stage, path Gleason score and margin status. A total of two thromboemoblic events occurred (0.6%) within 30 days of surgery (one in each arm of the study).• Heparin prophylaxis did not influence estimated blood loss (P= 0.076) or haematocrit change from preoperative levels (P= 0.378). Length of stay was comparable between the two groups (1.4 vs 1.3 days; P= 0.159).CONCLUSION• The incidence of thromboembolism is low after RALP, which may obviate the need for heparin prophylaxis. However, its use is safe and does not impact surgical outcomes. Larger series are needed to confirm the results obtained in the present study.

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Section: Introductionmentioning

confidence: 99%

Heparin prophylaxis and the risk of venous thromboembolism after robotic‐assisted laparoscopic prostatectomy

Patel¹,

Kirby

Hruby

et al. 2011

BJU International

View full text Add to dashboard Cite

show abstract

“…Before routine use of heparin prophylaxis in these patients, the incidence of venous thromboembolism (VTE) in patients undergoing major surgery, including major urological surgery, ranged from 15 to 40% [8,9], but even with adequate prophylaxis and early mobilization VTE rates of 1-5% can still be found [7,10,11]. Furthermore, pulmonary embolism is believed to be a major cause of postoperative mortality [11,12].…”

Section: Introductionmentioning

confidence: 99%

Incidence, risk profile and morphological pattern of venous thromboembolism after prostate cancer surgery

Beyer

Wessela

Hakenberg

et al. 2009

Journal of Thrombosis and Haemostasis

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To cite this article: Beyer J, Wessela S, Hakenberg OW, Kuhlisch E, Halbritter K, Froehner M, Wirth MP, Schellong SM. Incidence, risk profile and morphological pattern of venous thromboembolism after prostate cancer surgery. J Thromb Haemost 2009; 7: 597-604.Summary. Background: Venous thromboembolism (VTE) is the most common non-surgical complication after major pelvic surgery. Little is known about the risk factors or the time of development of postoperative venous thrombosis. Methods: A cohort of 523 consecutive patients undergoing radical prostatectomy with lymphadenectomy was prospectively assessed by complete compression ultrasound at days )1, +8 and +21. Results: Complete data were available in 415 patients, while four patients had VTE before surgery and were excluded from the analysis. In the remaining 411 patients, 71 VTE events were found in 69 patients (16.8%). Most were limited to calf muscle veins (56.5%), followed by deep calf vein thrombosis (23.2%), proximal deep vein thrombosis (DVT, 14.5%) and pulmonary embolism (PE, 5.8%). Of the 14 patients with proximal DVT/PE, 11 patients (78.6%) developed VTE between days 8 and 21. Risk factors for VTE were a personal history of VTE (OR 3.0), pelvic lymphoceles (LCs) impairing venous flow (OR 2.8) and necessity of more than two units of red blood cells (OR 2.6). Conclusion: Venous thromboembolism is common after radical prostatectomy. A significant proportion develops after day 8, suggesting that prolonged heparin prophylaxis should be considered. Since LCs with venous flow reduction result in higher rates of VTE, hemodynamically relevant lymphoceles should be surgically treated.

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“…3,4,6,7,[9][10][11] The overall incidence of DVT was reduced from 39% to 16% (RR 0.41; 95% CI 0.24-0.71). 3,4,[6][7][8]10,11,22 A study of 579 patients having radical prostatectomy did not find any difference in the number of pelvic lymphoceles or blood loss between those receiving LDUH and those not having prophylaxis. 23 The RCTs to study the efficacy of LMWH for VTE prevention in patients undergoing urologic surgery have not been performed.…”

Section: Prophylactic Methods and Recommendationsmentioning

confidence: 99%

Urologic Surgery

Nicolaides¹,

Fareed²,

Kakkar³

et al. 2013

Clin Appl Thromb Hemost

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Prevention of postoperative deep-vein thrombosis by low-dose heparin in open prostatectomy

Cited by 28 publications

References 13 publications

Heparin prophylaxis and the risk of venous thromboembolism after robotic‐assisted laparoscopic prostatectomy

Heparin prophylaxis and the risk of venous thromboembolism after robotic‐assisted laparoscopic prostatectomy

Incidence, risk profile and morphological pattern of venous thromboembolism after prostate cancer surgery

Urologic Surgery

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