Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous Heparin
Autor: | Vignesh T. Packiam, Vivek N. Prachand, Joseph J. Pariser, Shane M. Pearce, Blake B. Anderson, Gary D. Steinberg, Norm D. Smith |
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Rok vydání: | 2017 |
Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Renal function Cystectomy 03 medical and health sciences Postoperative Complications 0302 clinical medicine Subcutaneous heparin medicine Humans Blood Transfusion Enoxaparin Aged Retrospective Studies Inpatients Heparin business.industry Anticoagulants Venous Thromboembolism Middle Aged medicine.disease Surgery Pulmonary embolism Venous thrombosis Regimen Treatment Outcome 030220 oncology & carcinogenesis Anesthesia Female business Venous thromboembolism medicine.drug |
Zdroj: | Journal of Urology. 197:302-307 |
ISSN: | 1527-3792 0022-5347 |
DOI: | 10.1016/j.juro.2016.08.090 |
Popis: | Venous thromboembolic events are a significant source of morbidity after radical cystectomy. At our institution subcutaneous heparin was historically given to patients undergoing radical cystectomy immediately before incision and throughout the inpatient stay. In an effort to decrease the overall rate of venous thromboembolism and post-discharge venous thromboembolism, a regimen including extended duration enoxaparin was initiated for patients undergoing radical cystectomy.In January 2013 thromboprophylaxis was modified for patients undergoing radical cystectomy by replacing a regimen of subcutaneous heparin before induction and then every 8 hours until discharge home with enoxaparin daily for postoperative prophylaxis continued until 28 days after discharge. Data from our institutional radical cystectomy database for patients undergoing surgery from January 2011 to May 2014 were reviewed. The primary outcome was clinically symptomatic postoperative venous thromboembolism. Secondary outcomes included timing of venous thromboembolism and blood transfusions. Multivariate logistic regression was used to control for differences between cohorts.Of the 402 patients 234 underwent radical cystectomy before the change and 168 after. The enoxaparin regimen decreased the rate of venous thromboembolism (12% vs 5%, p=0.024) with the main benefit on post-discharge venous thromboembolism (6% vs 2%, p=0.039). Overall 17 of 37 (46%) venous thromboembolisms occurred after discharge home. Multivariate analysis confirmed that the enoxaparin regimen was independently associated with reduced odds of venous thromboembolism (OR 0.33, 95% CI 0.14-0.76, p=0.009). Intraoperative and postoperative transfusion rates were similar between cohorts.Thromboprophylaxis with extended duration enoxaparin decreased the rate of venous thromboembolism after radical cystectomy compared to inpatient only subcutaneous heparin with no increased risk of bleeding. |
Databáze: | OpenAIRE |
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