Venous thromboembolism after radical cystectomy: Experience with screening ultrasonography

• Published in: Arab Journal of Urology Vol. 14; no. 1; pp. 37 - 43
• Main Authors: Murray, Katie M., Parker, William, Stephany, Heidi, Redger, Kirk, Mirza, Moben, Lopez-Corona, Ernesto, Holzbeierlein, Jeffrey M., Lee, Eugene K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier B.V 01.03.2016; Taylor & Francis; Elsevier
• Subjects: BMI; body mass index; Deep vein thrombosis; DVT; EBL; estimated blood loss; length of hospital stay; LMWH; LOS; low-molecular weight heparin; Oncology/Reconstruction Original article; Pulmonary embolism; Radical cystectomy; Ultrasonography; Venous thromboembolism; VTE; DVT; VTE; Deep vein thrombosis; EBL; Pulmonary embolism; LMWH; LOS; RC; PE; Ultrasonography; Radical cystectomy; US; Venous thromboembolism; BMI; VTE, venous thromboembolism; PE, pulmonary embolism; BMI, body mass index; EBL, estimated blood loss; RC, radical cystectomy; LMWH, low-molecular weight heparin; LOS, length of hospital stay; DVT, deep vein thrombosis; US, ultrasonography
• ISSN: 2090-598X; 2090-598X; 2090-5998
• DOI: 10.1016/j.aju.2015.11.002

To detect the incidence of immediate postoperative deep vein thrombosis (DVT) using screening lower extremity ultrasonography (US) in patients undergoing radical cystectomy (RC) and to determine the rate of symptomatic pulmonary embolism (PE) after RC and identify risk factors for venous thromboembolic (VTE) events in a RC population. We performed a retrospective review of prospective data collected on patients who underwent RC between July 2008 and January 2012. These patients underwent screening US at 2/3days after RC to determine the rate of asymptomatic DVT. A chart review was completed to identify those who had a symptomatic PE. Univariate and multivariable analysis was used to identify risk factors associated with DVT, PE and total VTE events. In all, 221 patients underwent RC and asymptomatic DVT was identified in 21 (9.5%) on screening US. Nine (4.5%) developed symptomatic PE at a median of 9days, of which no patients had positive lower extremity US postoperatively. Increased length of hospital stay, increased estimated blood loss, and lower body mass index were linked to risk of PE, and only a previous history of DVT was associated with postoperative DVT. Patients who undergo RC are at high-risk for thromboembolic events and multimodal prophylaxis should be administered. Clinicians should be especially vigilant in those who demonstrate factors associated with higher risk for VTE events.