494 Is it Time to Reassess Thromboprophylaxis in Endourology?

Abstract

Abstract Introduction Evidence regarding risk of post-operative venous thromboembolism (VTE) versus bleeding in Endourology is acknowledged as weak. Sequela of both post-operative VTE and bleeding, whilst low in Endourology procedures, can represent significant morbidity and mortality for patients. European Association of Urology (EAU) guidelines advise against pharmacological VTE prophylaxis in Endourology procedures. A retrospective audit of the rate of VTE and bleeding, as well as adherence to EAU guidelines was performed. Method Patient data was gathered on those undergoing Endourology procedures at our institution, over a 6-week period. Medical records were reviewed for pre-operative VTE risk factors, VTE prescribing and adherence to EAU procedure-specific guidelines. The incidence of VTE and post-operative bleeding was also studied. Results A total of 21 patients underwent Endourology procedures, with 15 undergoing an Ureteroscopy, 5 Percutaneous Nephrolithotomies (PCNLs) and 1 Cystoscopy. One patient was identified as high-risk for VTE in accordance with the EAU guidelines. A further 7 and 13 patients were deemed as medium and low risk respectively. Pharmacological prophylaxis was prescribed in 66.6% of patients. No post-operative VTE or bleeding was reported. However, only 33.3% of patients had VTE prophylaxis prescribed in accordance with EAU guidelines. Conclusions The audit highlighted sub-optimal VTE prophylaxis prescribing in accordance with the EAU guidelines, with patients being over prescribed VTE prophylaxis. However, the criteria may underestimate potential morbidity and mortality in high-risk patient groups. It is therefore prudent to take into account patient and procedure risk, to more accurately estimate both VTE and post-operative bleeding.