PD08-09 INTERIM ANALYSIS OF A NATIONAL RETROSPECTIVE STUDY OF cT3b+ RENAL CELL CARCINOMA PATIENTS’ PULMONARY EMBOLISM RISK AND THROMBOPROPHYLAXIS MANAGEMENT

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD08-09 INTERIM ANALYSIS OF A NATIONAL RETROSPECTIVE STUDY OF cT3b+ RENAL CELL CARCINOMA PATIENTS’ PULMONARY EMBOLISM RISK AND THROMBOPROPHYLAXIS MANAGEMENT Osman El-Koubani, James Blackmur, Flora Rodgers, Gianluca Maresca, Lucy Drummond, Caroline Bradley, Siobhan Duffy, Satchi Swami, Khalid Janjua, Steve Leung, Ross Clark, Gavin Lamb, Alex Chapman, James Donaldson, Grenville Oades, and Alexander Laird Osman El-KoubaniOsman El-Koubani More articles by this author , James BlackmurJames Blackmur More articles by this author , Flora RodgersFlora Rodgers More articles by this author , Gianluca MarescaGianluca Maresca More articles by this author , Lucy DrummondLucy Drummond More articles by this author , Caroline BradleyCaroline Bradley More articles by this author , Siobhan DuffySiobhan Duffy More articles by this author , Satchi SwamiSatchi Swami More articles by this author , Khalid JanjuaKhalid Janjua More articles by this author , Steve LeungSteve Leung More articles by this author , Ross ClarkRoss Clark More articles by this author , Gavin LambGavin Lamb More articles by this author , Alex ChapmanAlex Chapman More articles by this author , James DonaldsonJames Donaldson More articles by this author , Grenville OadesGrenville Oades More articles by this author , and Alexander LairdAlexander Laird More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003239.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to 10% of patients with renal cell carcinoma (RCC) have venous tumour thrombus at diagnosis. The incidence of PE in patients with RCC invading the venous system is unknown. The role of anticoagulation to prevent PE in such patients is also unknown and there is currently no guidance on whether patients should receive anticoagulation at diagnosis. We aimed to determine the incidence of PE is patients with RCC invading the inferior vena cava, understand the pattern of prophylactic anticoagulation prescribing in such patients and assess the effect of anticoagulation of PE risk. METHODS: We performed a retrospective review of records for all consecutive patients with cT3b, cT3c or cT4 with associated IVC thrombus (T3b+) RCC from 9 centres across a nation between Jan 2017 and Dec 2020. Patient demographics, comorbidities, anticoagulation prescription and outcomes were recorded. RESULTS: Data from 6 of 9 units was available for analysis, including 162 patients with RCC and IVC thrombus. 94(58%) patients were male and the median age was 68yrs (range: 31-93yrs). 112 (69.1%) patients died during follow-up.42(25.9%) patients developed a PE during the study period. PE was more common with larger venous tumour thrombus (10/64 patients [15.5%] level 1, 32/98 patients [32.7%] level 2+; p=0.17). 27(16.7%) patients had a PE at initial RCC diagnosis while 15 (11.1%) of the remaining 135 patients subsequently developed a PE during their management. Of the 135 patients, 11 (8.1%) patients, 27(20%) patients, and 97(71.9%) patients were commenced on prophylactic dose, treatment dose or no anticoagulation respectively. While not significant, there was a trend for higher rate of PE in the non-anticoagulated group, compared with those receiving prophylactic anticoagulation and treatment dose anticoagulation after diagnosis of T3b+ RCC (13[13.4%], 1[9.0%] and 1[3.7%] respectively, p=0.357). There was a higher rate of post-diagnosis haematuria in the anticoagulated group compared to the non-anticoagulated group (15.4% and 7.7%, p=0.122). CONCLUSIONS: In this interim analysis, we demonstrate a significant risk of concurrent or subsequent diagnosis of PE in those patients with cT3b+ RCC, which is related to venous tumour thrombus level. There is heterogeneity in the approach to prescribing anticoagulant prophylaxis in these patients. However, there is a trend for a reduction in the diagnosis of PE in those patients who receive anticoagulation following diagnosis of cT3b+ RCC, although this may result in higher rates of haematuria. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e236 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Osman El-Koubani More articles by this author James Blackmur More articles by this author Flora Rodgers More articles by this author Gianluca Maresca More articles by this author Lucy Drummond More articles by this author Caroline Bradley More articles by this author Siobhan Duffy More articles by this author Satchi Swami More articles by this author Khalid Janjua More articles by this author Steve Leung More articles by this author Ross Clark More articles by this author Gavin Lamb More articles by this author Alex Chapman More articles by this author James Donaldson More articles by this author Grenville Oades More articles by this author Alexander Laird More articles by this author Expand All Advertisement PDF downloadLoading ...