PD59-09 EXTENDED ANTICOAGULATION AFTER RADICAL CYSTECTOMY: A SINGLE-INSTITUTIONAL EXPERIENCE

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You have accessJournal of UrologyBladder Cancer: Invasive V (PD59)1 Sep 2021PD59-09 EXTENDED ANTICOAGULATION AFTER RADICAL CYSTECTOMY: A SINGLE-INSTITUTIONAL EXPERIENCE Kassem Faraj, Derek Scott, Rohan Singh, and Mark Tyson Kassem FarajKassem Faraj More articles by this author , Derek ScottDerek Scott More articles by this author , Rohan SinghRohan Singh More articles by this author , and Mark TysonMark Tyson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002096.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extended anticoagulation therapy has been found to be effective in reducing the risk of developing venous thromboembolism (VTE) in trials evaluating major oncological surgeries. This practice has not been universally adopted in the care of patients undergoing radical cystectomy. At our institution, we have modified our extended anticoagulation options to low-dose oral options. This study aims to report our experience with extended VTE prophylaxis and our experience with oral options at the time of RC. METHODS: This is a retrospective review that included all patients who underwent RC at our institution between 01/2007-06/2020. Exclusion criteria included the following: patients with a prior history of VTE, those on anticoagulation prior to surgery, thrombosis events after 90 days, RC for benign indication, and RC for non-bladder indication. Extended anticoagulation was continued for 30 days after surgery and included either daily 40 mg subcutaneous enoxaparin, daily 10 mg rivaroxaban, or 2.5 mg apixaban twice per day. Descriptive statistics were performed to evaluate characteristics of patients who developed a symptomatic VTE verses those with did not. We then performed a multivariable logistics regression analysis to identify factors associated with the development of a VTE. RESULTS: In 616 patients, the median age was 72 years, medium BMI 28. Seventy-four patients received some form of extended VTE prophylaxis. On descriptive analysis, a deep vein thrombosis (DVT) was less common in the extended prophylaxis cohort, though this was not statistically significant (1.4% vs 5.4%, p=0.132). The incidence of pulmonary embolism was similar in the cohorts (2.7% vs 3.2%, p=0.834). Of the 74 patients who received extended VTE prophylaxis, 15 (20.2%) and 9 (12.2%) patients received rivaroxaban and Eliquis, respectively. The incidence of gastrointestinal bleed was low in the entire cohort and no patients in the extended DVT group developed a gastrointestinal bleed, compared to 1.5 % in the control group (p=0.376). On multivariable analysis, extended VTE prophylaxis was associated with a reduced risk of developing VTE and this approached statistical significance (OR 0.32, p=0.08). CONCLUSIONS: Extended DVT prophylaxis is associated with a reduced risk of developing a symptomatic VT after RC. Oral anticoagulant options are just as safe and appear to be associated with low rates of VTE, though larger studies are needed to confirm these results. Source of Funding: This study was generously supported by funding from the Robert D. and Patricia E. Kern Center for Health Care Delivery Science, the Christian Haub Family Career Development Award for Cancer Research Honoring Dr Richard Emslander, and the Eric and Gail Blodgett Foundation. The sponsors were not involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1057-e1057 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kassem Faraj More articles by this author Derek Scott More articles by this author Rohan Singh More articles by this author Mark Tyson More articles by this author Expand All Advertisement Loading ...