Thromboprophylaxis in Urological and Andrological Surgery (Review article)
##plugins.themes.bootstrap3.article.sidebar##
##plugins.themes.bootstrap3.article.main##
Abstract
Last decades urologist started to performed big amount of complicated oncological operation with substantial risk of both venous thromboembolism (VTE) and bleeding. Prophylaxis of VTE remains a vital problem, as it is potentially fatal and is associated with significant morbidity. Prophylaxis of this complication is not clearly defined and is mainly based on information from other surgical specialties (like orthopedic or general surgery). Scientific publications dedicated VTE prophylaxis in field of urology were reported only in the last decade.
Most studies showed that pharmacological prophylaxis decreases the relative risk of VTE in surgical patients by approximately 50%, but with an increase in the relative risk of postoperative major bleeding of 50%. Main models for evaluation of different VTE risk factors were analyzed. The most important risk factors for VTE are age of 75 or more, body mass index 35 or more, prior VTE or VTE in 1st degree relative. As for urological procedure, deep venous thrombosis rates of 0.2–7.8% and pulmonary embolism of 0.2–7% have been reported.
It was shown that recommendations for VTE prophylaxis varies in different guidelines and their summary for most popular operations were described. Generally, most recommendations state that low-risk procedures need no prophylaxis or solely mechanical prophylaxis. Moderate-risk categories can either have mechanical or pharmacological prophylaxis. The high-risk category should have both mechanical and pharmacological prophylaxis, and extended prophylaxis should be considered.
Despite massive evidences about risk of VTE among different types of surgical patients, real clinical practice doesn’t show the strict adherence to VTE prophylaxis recommendations.
##plugins.themes.bootstrap3.article.details##
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain the copyright and grant the journal the first publication of original scientific articles under the Creative Commons Attribution 4.0 International License, which allows others to distribute work with acknowledgment of authorship and first publication in this journal.
References
Saluja, M. and Gilling, P. (2017), Venous thromboembolism prophylaxis in urology: A review. Int. J. Urol., 24: 589–593. https://doi.org/10.1111/iju.13399
Tikkinen K.A.O. (Chair), Cartwright R., Gould M.K., et al. Guidelines on Thromboprophylaxis in Urological Surgery. http://uroweb.org/guideline/thromboprophylaxis/
Tikkinen K.A.O., Craigie S., Agarwal A. et al. Procedure-specific risks of thrombosis and bleeding in urological cancer surgery: systematic review and meta-analysis. Eur Urol. 2018; 73: 242–251.
Michalski, W., Poniatowska, G., Jonska-Gmyrek, J. et al. Venous thromboprophylaxis in urological cancer surgery. Med Oncol 37, 11 (2020). https://doi.org/10.1007/s12032-019-1331-8
Badireddy M, Mudipalli VR. Deep Venous Thrombosis Prophylaxis. [Updated 2021 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534865/
Klaassen Z, Wallis CJD, Lavallee LT, Violette PD. Perioperative venous thromboembolism prophylaxis in prostate cancer surgery. World J Urol. 2020 Mar;38(3):593–600. doi: 10.1007/s00345-019-02705-x. Epub 2019 Mar 6. PMID: 30840115.
Gould MK, Garcia DA, Wren SM et al. Prevention of VTE in non-orthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141(2 Suppl): e227S–77S.
Krasnow R, Gelpi-Hammerschmidt F, Preston M et al. MP63-08 Validation of the Caprini risk assessment model in radical cystectomy patients. J. Urol. 2016; 195(Suppl): e823–4.
Lassen, M.R., et al. Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomized double-blind trial. Lancet, 2010. 375: 807. https://www.ncbi.nlm.nih.gov/pubmed/20206776
Lassen, M.R., et al. Apixaban versus enoxaparin for thromboprophylaxis after hip replacement. N Engl J Med, 2010. 363: 2487. https://www.ncbi.nlm.nih.gov/pubmed/21175312
Violette PD, Cartwright R, Briel M, Tikkinen KA, Guyatt GH. Guideline of guidelines: thromboprophylaxis for urological surgery. BJU Int 2016;118:351–8.
Anderson DR, Morgano GP, Bennett C, et al. American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv 2019;3:3898–944.
Geerts WH, Pineo GF, Heit JA et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on antithrombotic and thrombolytic therapy. Chest 2004; 3(Suppl): 338S– 400S.
Scurr JH, Coleridge-Smith PD, Hasty JH. Regimen for improved effectiveness of intermittent pneumatic compression in deep venous thrombosis prophylaxis. Surgery 1987; 102: 816–20.
Pavon JM, Adam SS, Razouki ZA et al. Effectiveness of intermittent pneumatic compression devices for venous thromboembolism prophylaxis in high-risk surgical patients: a systematic review. J. Arthroplasty 2016; 31: 524–32.
Wickham N, Gallus AS, Walters BN, Wilson A. Committee NVPGA. Prevention of venous thromboembolism in patients admitted to Australian hospitals: summary of National Health and Medical Research Council clinical practice guideline. Intern. Med. J. 2012; 42: 698–708.
Roderick P, Ferris G, Wilson K et al. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis. Health Technol. Assess. 2005; 9: iii– iv, ix–x, 1–78.
Forsh DA, Panchbhavi VK. Deep Venous Thrombosis Prophylaxis in Orthopedic Surgery [Internet]. In: Panchbhavi VK, editor. Medscape; 2021. Available from: https://emedicine.medscape.com/article/1268573-overview#a1
Rice KR, Brassell SA, McLeod DG. Venous thromboembolism in urologic surgery: prophylaxis, diagnosis, and treatment. Rev. Urol. 2010; 12: e111–24.
Canadian Urological Association guideline: Perioperative thromboprophylaxis and management of anticoagulation. Can Urol Assoc J 2019;13(4):105–14. http://dx.doi.org/10.5489/cuaj.5828
Pridgeon S, Allchorne P, Turner B, Peters J, Green J. Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: a UK national audit. BJU Int 2015;115:223–9.
National Institute for Health and Care Excellence. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. NICE guideline [NG89]. https://www.nice.org.uk/guidance/ng89
Craigie S, Tsui JF, Agarwal A, Sandset PM, Guyatt GH, Tikkinen KA. Adherence to mechanical thromboprophylaxis after surgery: a systematic review and meta-analysis. Thromb. Res. 2015; 136: 723–6.
Sterious S, Simhan J, Uzzo RG et al. Familiarity and self-reported compliance with American Urological Association best practice recommendations for use of thromboembolic prophylaxis among American Urological Association members. J. Urol. 2013; 190: 992–8.
Burleigh E, Wang C, Foster D. et al. Thromboprophylaxis in Medically Ill Patients at Risk for Venous Thromboembolism. Am J Health Syst Pharm. 2006;63(20):S23–S29.
Violette P. D., Vernooij R., Aoki Y et al. An International Survey on the Use of Thromboprophylaxis in Urological Surgery. European Urology Focus, Volume 7, Issue 3, 2021, Pages 653–658. https://doi.org/10.1016/j.euf.2020.05.015
Samama CM, Boubli L, Coloby P, et al. Venous thromboembolism prophylaxis in patients undergoing abdominal or pelvic surgery for cancer – a real-world, prospective, observational French study: PReOBS. Thromb Res. 2014 Jun;133(6):985–92. doi: 10.1016/j.thromres.2013.10.038. Epub 2013 Nov 1. PMID: 24231117.
