| Venous thromboembolism in radical prostatectomy: is heparinoid prophylaxis warranted? | |
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MedLine Citation:
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PMID: 16225520 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To review the incidence of venous thromboembolism (VTE) after radical retropubic prostatectomy (RRP) and evaluate the need for heparinoid prophylaxis as opposed to mechanical compression devices after RRP. PATIENTS AND METHODS: RRP is classified as a category 1 (high risk) procedure for VTE by the American College of Chest Physicians and several international guidelines recommend subcutaneous heparinoids as the preferred prophylaxis. However, this regimen may be associated with a greater risk of bleeding. We have not used heparinoid prophylaxis but place a mechanical compression device for prophylaxis of VTE, and report our clinical experience over a 12-year period. Between 1992 and 2004, all RRPs carried out by one surgeon (M.S.S.) at our centre were retrospectively reviewed after obtaining institutional review board approval. The protocol for prophylaxis of VTE consisted of compression stockings and a sequential compression device from the time of entry into the operating room until complete ambulation (we encourage early ambulation). Patients were evaluated for VTE if they developed any clinical signs or symptoms. Patients were followed at 7 days, 6 weeks and 3 months after RRP in the first year and 6-monthly thereafter. All relevant clinical data and complications were entered in a database. RESULTS: In all there were 1364 RRPs; the mean (sd) age of the patients was 61 (7) years and the mean follow-up 44 (38) months. All patients had a mechanical compression device and ambulated on the first day after surgery. None received heparinoid prophylaxis. Three VTE events were identified (0.21%); two patients had a lower limb VTE and one an upper limb VTE. All were successfully treated with anticoagulation. No patient had a documented pulmonary embolus and none died from VTE. There was one death after RRP, from myocardial infarction. CONCLUSION: The incidence of VTE after RRP is low, possibly related to the use of a mechanical compression device and early aggressive mobilization. Despite the recommendations by some, we feel that routine heparinoid prophylaxis is questionable. |
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Authors:
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Madhusudan P Koya; Murugesan Manoharan; Sandy S Kim; Mark S Soloway |
Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: BJU international Volume: 96 ISSN: 1464-4096 ISO Abbreviation: BJU Int. Publication Date: 2005 Nov |
Date Detail:
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Created Date: 2005-10-17 Completed Date: 2005-11-15 Revised Date: 2006-07-18 |
Medline Journal Info:
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Nlm Unique ID: 100886721 Medline TA: BJU Int Country: England |
Other Details:
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Languages: eng Pagination: 1019-21 Citation Subset: IM |
Affiliation:
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Department of Urology, University of Miami School of Medicine, Miami, FL 33101, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anticoagulants / therapeutic use* Bandages Early Ambulation Follow-Up Studies Hemostasis, Surgical / instrumentation Heparin, Low-Molecular-Weight / therapeutic use* Humans Incidence Male Middle Aged Patient Selection* Postoperative Complications / prevention & control* Prostatectomy* Retrospective Studies Thromboembolism / prevention & control Thrombosis / prevention & control* Venous Thrombosis / prevention & control |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Heparin, Low-Molecular-Weight |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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