Thromboprophylaxis in urological patients: to whom, how long, too much or too little?

DOI: 10.22591/magyurol.2018.4.molnara.156

Authors:
Molnár Ágnes dr., Villányi Kinga dr., Szántó Árpád dr.
Pécsi Tudományegyetem KK, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)

Summary

Due to the hypercoagulable state induced by surgery, serious complications of urological surgery include deep vein thrombosis and pulmonary embolism – together referred to as venous thromboembolism (VTE) – and major bleeding. Decisions regarding thromboprophylaxis using perioperative and postoperative low molecular weight heparin (LMWH) administration in urologic surgery involve a trade‐off between decreased risk of venous thromboembolism and increased risk of bleeding. Currently, there exists substantial practice variation in the use of thromboprophylaxis in urology, both within and between countries. This variation is unsurprising when one considers that recommendations from national and international guidelines often conflict. Consideration of LMWV administration, timing, dosage and duration are also a matter of debate in international literature. However, the majority of existing guidelines typically suggest thromboprophylaxis for most patients. Both patient‐ and procedure‐specific factors are critical in making an informed decision on the use of thromboprophylaxis.
Our aim is to summarize Guidelines proposal and to provide procedure and patient risk-specific guidance weighing the benefit of reduced VTE with the harm of increased bleeding.

click here to read the full article