Effectiveness and safety of extended-duration prophylaxis for venous thromboembolism in major urologic oncology surgery

Kukreja, Janet Baack; Levey, Helen R.; Scosyrev, Emil; Kiernan, Maureen; Berrondo, Claudia; McNamee, Carrie; Wu, Guan; Joseph, Jean; Ghazi, Ahmed; Rashid, Hani; Dozier, Ann; Messing, Edward M.

doi:10.1016/j.urolonc.2014.12.010

Cited by 40 publications

(29 citation statements)

References 27 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%

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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%

“…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 role of extended venous thromboembolism prophylaxis for major urological cancer operations

et al. 2019

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“…The authors of this study compared outcomes of thromboprophylaxis in patients undergoing urologic cancer surgery in the context of prophylaxis duration (prophylaxis in the hospital vs prophylaxis for 28 days after surgery). In the group receiving prolonged prevention VTE occurred in 7% of cases, whereas in 17% of patients, who received treatment in the hospital VTE was diagnosed; there were no differences in the bleeding rates between the groups [253].…”

Section: Venous Thromboembolism Prophylaxis In Cancer Patientsmentioning

confidence: 80%

“…VanDlac et al reported that in a group of 1,307 patients after radical cystectomy, 55% of VTE events were diagnosed after discharge [252]. The study performed by Kukreja et al, is one of the few works on appropriate antithrombotic prophylaxis duration in urology [253]. The authors of this study compared outcomes of thromboprophylaxis in patients undergoing urologic cancer surgery in the context of prophylaxis duration (prophylaxis in the hospital vs prophylaxis for 28 days after surgery).…”

Section: Venous Thromboembolism Prophylaxis In Cancer Patientsmentioning

confidence: 97%

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

Urbanek¹,

Krasiński

Kostrubiec

et al. 2017

Acta Angiologica

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“…Rates of major bleeding, PE and overall survival did not differ between the groups . Furthermore, extended prophylaxis in high‐risk surgeries might be more cost‐effective …”

Section: Types Of Thromboprophylaxismentioning

confidence: 91%

Venous thromboembolism prophylaxis in urology: A review

Saluja

Gilling

2017

Int J of Urology

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Venous thromboembolism is potentially a lethal problem, and is associated with chronic morbidity. Venous thromboembolism is frequently diagnosed after urological surgery, yet the role of perioperative venous thromboembolism prophylaxis is not clearly defined. Any current recommendations are largely based on evidence derived from other surgical specialties. Even within different guidelines, there remains significant variation, suggesting a consensus is required. The present review aims to define the problem of venous thromboembolism within the urological population, and identifies patients at risk. It evaluates the role of various types of mechanical and pharmacological prophylaxis, along with its timing and duration of administration in common urological operations. The current guidelines are summarized and compared in order to give the reader a better perspective of this vital condition.

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Effectiveness and safety of extended-duration prophylaxis for venous thromboembolism in major urologic oncology surgery

Cited by 40 publications

References 27 publications

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

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

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

Venous thromboembolism prophylaxis in urology: A review

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