MP50-05 IDENTIFYING PRACTICE PATTERNS FOR THROMBOPROPHYLAXIS AFTER RADICAL CYSTECTOMY.

Abstract

You have accessJournal of UrologyBladder Cancer: Natural History & Pathophysiology1 Apr 2014MP50-05 IDENTIFYING PRACTICE PATTERNS FOR THROMBOPROPHYLAXIS AFTER RADICAL CYSTECTOMY. Amanda VanDlac, MD Nicholas Cowan, MD Yiyi Chen, MD Jeffery La Rochelle, MD Christopher Amling, andMD Theresa KoppieMD Amanda VanDlacAmanda VanDlac More articles by this author , Nicholas CowanNicholas Cowan More articles by this author , Yiyi ChenYiyi Chen More articles by this author , Jeffery La RochelleJeffery La Rochelle More articles by this author , Christopher AmlingChristopher Amling More articles by this author , and Theresa KoppieTheresa Koppie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1126AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives A retrospective review of the National Surgical Quality Improvement Program database determined the incidence of venous thrombotic events was 6%. While this number is alarming it is similar to previous studies. However the more surprising finding in that study was more than half of those events occurred after discharge (VanDlac et al, 2013). Guidelines have begun to recognize the need for chemical prophylaxis after discharge. Current guidelines from the American College of Chest Physicians (ACCP) recommend “extended-duration pharmacologic prophylaxis with Low molecular weight heparin (LMWH) over limited-duration prophylaxis for high-risk venous thromboembolism (VTE) patients which would include cystectomies. The AUA does not comment on extended duration prophylaxis (AUA guidelines 2011). Both these sets of recommendations rely on extrapolation from studies in general surgery and prostatectomy literature, not cystectomies. Our objective was to identify practice patterns regarding methods and length of thromboprophylaxis for patients undergoing radical cystectomy for bladder cancer. Methods A 12 question survey was distributed at a 2013 Bladder Cancer Think Tank meeting. 37 surveys were completed. Data regarding graduation year, frequency of performing cystectomies, location of practice, strategies for prophylaxis, preoperative and postoperative prophylaxis, timing of prophylaxis, preferred pharmacologic regimen, screening for deep vein thrombosis and length of treatment was collected. This data was analyzed and practice patterns were identified. Results 37 surveys were completed. 24 urologists (65%) prescribe a dose of pharmacologic prophylaxis immediately prior to radical cystectomy. 23 (62%) initated post operative prophylaxis on post operative day 0, 13 (35%) on post operative day 1. 24 (65%) do not screen for DVTs. 19 (51%) used inpatient prophylaxis while 16 (43%) use both inpatient and outpatient prophylaxis. 16 (43%) preferred lovenox as their post-operative pharmacologic prophylaxis regimen while 30 (54%) preferred heparin. 1 week of postoperative prophylaxis was recommended by 5 (14%), 2 weeks by 1 (2.7%), 4 weeks by 15 (43%), and 5 weeks by 1 (2.7%). Conclusions Based on these findings from those considered experts in the field of bladder cancer, urologists should strongly consider post operative prophylactic pharmacology. There is no universally defined length of treatment but considering almost half of this group recommended 4 weeks of prophylaxis,urologists can consider a similar length of course, especially in their higher risk patients. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e495 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Amanda VanDlac More articles by this author Nicholas Cowan More articles by this author Yiyi Chen More articles by this author Jeffery La Rochelle More articles by this author Christopher Amling More articles by this author Theresa Koppie More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...