Abstract: PD36-10
Sources of Funding: None

Introduction

Venous thromboembolism (VTE), comprised of deep venous thrombosis (DVT) and pulmonary embolus (PE), remains a significant complication following radical cystectomy. Recently, utilization of prophylactic dosed post-discharge subcutaneous enoxaparin has been reported to decrease VTE rates following radical cystectomy. We compared the rates of VTE following radical cystectomy at post-operative day 90 during three separate eras where patients received either prophylaxis with warfarin (1985-2007), subcutaneous heparin (2009-2012) while hospitalized, or subcutaneous heparin followed by 30-days of subcutaneous enoxaparin (2013-2015) following discharge.

Methods

We used a prospectively maintained database to identify all patients who underwent radical cystectomy for primary bladder cancer with intent to cure at our institution from 1985-2015. Rates of VTE during the three different eras of VTE prophylaxis were calculated and compared. Multivariable logistic regression modeling was used to identify independent risk factors for VTE following radical cystectomy.

Results

2694 patients were identified during this time period and 168 patients were excluded for missing data. A total of 4.43% (n=112, 57 DVT only) patients developed VTE. Rates of VTE were not significantly different between methods of VTE prophylaxis, (p=0.8673). Multivariable logistic regression analysis identified age (OR 1.027, 95%CI 1.003-1.051), BMI (OR 1.073, 95%CI 1.034-1.113), non-orthotopic diversion (OR 0.456, 95%CI 0.261-0.794), and hospital length-of-stay (OR 1.038, 95%CI 1.011-1.064) to be independent predictors of VTE.

Conclusions

VTE rates in patients treated with extended post-discharge prophylactic dosed subcutaneous enoxaparin were not significantly different than VTE rates in patients treated with warfarin or subcutaneous heparin while hospitalized at 90 days post-operatively. Age, BMI, non-orthotopic urinary diversion, and hospital length-of-stay were independent predictors for VTE in patients following radical cystectomy. These results conflict with recently published reports and highlight the need for a randomized controlled trial for VTE prophylaxis following radical cystectomy. _x000D_

Funding

None