MP06-02 SAFETY AND EFFICACY OF EXTENDED-DURATION THROMBOEMBOLIC PROPHYLAXIS FOLLOWING RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation II1 Apr 2016MP06-02 SAFETY AND EFFICACY OF EXTENDED-DURATION THROMBOEMBOLIC PROPHYLAXIS FOLLOWING RADICAL CYSTECTOMY Harras Zaid, David Yang, Matthew Tollefson, Igor Frank, William Parker, R. Houston Thompson, R. Jeffrey Karnes, and Stephen Boorjian Harras ZaidHarras Zaid More articles by this author , David YangDavid Yang More articles by this author , Matthew TollefsonMatthew Tollefson More articles by this author , Igor FrankIgor Frank More articles by this author , William ParkerWilliam Parker More articles by this author , R. Houston ThompsonR. Houston Thompson More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , and Stephen BoorjianStephen Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2163AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Venous thromboembolism (VTE) has been reported in approximately 5-7% of patients undergoing radical cystectomy (RC). While extended-duration pharmacologic prophylaxis (EDPP) has been investigated following surgery for a variety of malignancies, limited data exist regarding usage in bladder cancer. Herein, we evaluated the efficacy and safety of EDPP after RC. METHODS We instituted a change in our clinical practice beginning May 2014 such that patients undergoing RC were prescribed 30 days of enoxaparin at discharge. We recorded symptomatic VTEs and lymphoceles within 30 days of RC among patients treated from 5/14-6/15, and compared these outcomes to patients who underwent RC at our institution in the year prior to EDPP implementation. Patients in both groups received subcutaneous unfractionated heparin at anesthesia induction, which was continued TID during hospitalization, in addition to lower extremity sequential compression devices. Patients with a history of VTE prior to surgery (n=24) were excluded from study. Unadjusted descriptive statistics were performed using the Pearson chi-square test for categorical variables and Wilcoxon rank-sum test for continuous variables. RESULTS In total, 58 patients who received EDPP and 82 patients who had not received EDPP after RC were included for analysis. Baseline clinicopathologic demographics were similar between the cohorts (Table). We found that only 1 patient (1.9%) discharged with EDPP was diagnosed with a VTE within 30 days of RC, compared to 5 (6.1%) who had not received EDPP. Mean time to VTE was 18.0 days after RC (range 9-28 days). Events consisted of DVT alone (n=2), DVT and PE (n=2), and PE alone (n=2). The odds ratio for VTE in the absence of EDPP was 3.31 (95% CI 0.38, 29.2). Overall, 3 patients developed a symptomatic lymphocele within 30 days of RC: 1 (1.9%) who received EDPP and 2 (2.4%) who had not (p = 0.84). No patient in either cohort was rehospitalized for bleeding complications. CONCLUSIONS Our initial experience suggests that EDPP was associated with a lower rate of VTE following RC, and does not increase the risks of bleeding or symptomatic lymphocele. Future evaluation in a larger-scale prospective clinical trial setting is needed to confirm the benefit of EDPP in RC patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e66 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Harras Zaid More articles by this author David Yang More articles by this author Matthew Tollefson More articles by this author Igor Frank More articles by this author William Parker More articles by this author R. Houston Thompson More articles by this author R. Jeffrey Karnes More articles by this author Stephen Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...