Login to Access Video or Poster Abstract: MP92-01
Sources of Funding: None

Introduction

Patients undergoing major urologic oncology surgery are at risk for post-operative venous thromboembolic events (VTE). The development of VTE following surgery often presents clinically after discharge and is associated with potentially significant morbidity and mortality. At present there is little published data on the safety and efficacy of extended duration venous thromboembolism prophylaxis (EDVTP) beyond the time of hospital discharge in urologic oncology patients. In this study, we evaluate the use of EDVTP for post-operative high-risk urologic oncology patients.

Methods

All patients undergoing major urologic oncology surgery by a single surgeon at our institution from April 2015 to present were evaluated for their risk for VTE using the Caprini risk assessment model. Patients considered high-risk (Caprini score ≥ 5) were discharged on post-operative EDVTP according to 2012 ACCP guidelines. 28 days of postoperative subcutaneous enoxaparin was considered the standard of care in eligible patients. These patients were prospectively monitored for the development of clinically symptomatic VTE within 30 days postoperatively and for adverse effects of EDVTP.

Results

150 patients who underwent major urologic oncology surgery were considered to be at high VTE risk based on Caprini score of ≥ 5. Average patient age was 63.3 years and 68% of the patients were male. Surgical procedures performed included 39% radical cystectomy, 29% nephrectomy, 16% partial nephrectomy and 16% other. Average Caprini score was 7. Of these, 75% were candidates to receive a 28 day course of enoxaparin EDVTP. The most common reasons for the 25% of patients not receiving standard enoxaparin EDVTP included renal insufficiency (31%), atrial fibrillation requiring oral anticoagulation (26%), and previously diagnosed VTE requiring therapeutic anticoagulation (16%). Adherence to guidelines was not associated with any VTE prophylaxis complications. There were also no noted complications from the use of enoxaparin. The rate of observed 30-day symptomatic VTE in this population was 0%, with an anticipated rate of >5% based upon Caprini score.

Conclusions

Post-operative use of EDVTP appears to be a safe and effective way to decrease the risk of VTE in high-risk urologic oncology patients. Additional data from larger registries is needed to evaluate and confirm the benefit gained and need for use of EDVTP in this patient population.

Funding

None