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Does Heparin Prophylaxis Reduce the Risk of Venous Thromboembolism in Patients Undergoing Robotic Prostatectomy?
MedLine Citation:
PMID:  23286308     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Purpose: Venous thromboembolism (VTE) is a major complication of urologic surgery. Data is limited regarding the benefits of heparin prophylaxis for patients undergoing minimally invasive urologic surgery. The AUA recommends sequential compression devices (SCDs) for urologic laparoscopic and robotically assisted procedures but provides no clear recommendations for the use of pharmacologic prophylaxis. We compare the rates of post-operative VTE in two groups of patients undergoing robotic prostatectomy (RP) by two surgeons; one who consistently used heparin with SCDs (Group 1) and the other who used SCDs alone (Group 2) for prophylaxis. Methods: An IRB approved, prospectively managed database was analyzed. Group 1 received SCDs just prior to induction and 5,000 units of heparin subcutaneously just after induction. SCDs continued post-operatively and heparin was given twice a day until discharge. VTE rate, patient age, BMI, operative time, lymphocele rate, length of stay (LOS), estimated blood loss (EBL), Gleason score and pathologic stage were compared. Categorical variables were analyzed with chi square test of proportions and continuous variables with t-test using SPSS v 14 software. Results: 1,486 consecutive patients underwent RP between August, 2007 and December 30, 2011. 922 patients received heparin/SCDs and 564 received SCDs alone. Age, BMI, EBL, medial LOS, Gleason score and pathologic stage were the same in the two groups. There was a higher rate of positive nodes in Group 2 (1.3% vs 3.5%). There was one lymphocele in each group. Although operative times were longer in Group 2 (229 vs 170 min, p<0.001), the incidence of VTE was not statistically different (1.0% v 0.7%, p=.78). BMI, operative time, EBL, and the performance of lymph node dissection were not associated with VTE. Conclusions: The risk of VTE in patients undergoing RP is low and not significantly reduced with the administration of prophylactic heparin/SCDs compared to SCDs alone.
Authors:
David Chalmers; Kristen Scarpato; Ilene Staff; Alison Champagne; Joseph Tortora; Joseph R Wagner; Stuart S Kesler
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-3
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  -     ISSN:  1557-900X     ISO Abbreviation:  J. Endourol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
University of Connecticut Medical Center, Urology, Farmington, Connecticut, United States; dchalmers55@gmail.com.
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