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AUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery

2009; Lippincott Williams & Wilkins; Volume: 181; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2008.12.027

1527-3792

John B. Forrest, J. Quentin Clemens, Peter S. Finamore, Raymond J. Leveillee, Marguerite Lippert, Louis L. Pisters, Karim Touijer, K. E. Whitmore,

Vascular Procedures and Complications

No AccessJournal of UrologyAdult Urology1 Mar 2009AUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery John B. Forrest, J. Quentin Clemens, Peter Finamore, Raymond Leveillee, Marguerite Lippert, Louis Pisters, Karim Touijer, and Kristine Whitmore John B. ForrestJohn B. Forrest , J. Quentin ClemensJ. Quentin Clemens , Peter FinamorePeter Finamore , Raymond LeveilleeRaymond Leveillee , Marguerite LippertMarguerite Lippert , Louis PistersLouis Pisters , Karim TouijerKarim Touijer , and Kristine WhitmoreKristine Whitmore View All Author Informationhttps://doi.org/10.1016/j.juro.2008.12.027AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : A critical analysis of perioperative mortality from radical cystectomy. J Urol2006; 175: 886. Link, Google Scholar 2 : Prospective 12 year follow up study of clinical and hemodynamic sequelae of deep vein thrombosis in low risk patients. Circulation1996; 93: 74. Google Scholar 3 : The long term clinical course of acute deep vein thrombosis. Ann Intern Med1996; 125: 1. Google Scholar 4 : Cost of long term sequelae of deep vein thrombosis of the lower extremities: An analysis of a defined patient population in Sweden. Ann Intern Med1997; 126: 454. Google Scholar 5 : Prevention of venous thromboembolism: International consensus statement. J Vasc Biol2002; 1: 133. Google Scholar 6 : Prophylaxis of fatal pulmonary embolism in general surgery using low-molecular weight heparain Cy 216; a multicentre, double-blind, randomized, controlled, clinical trial verus placebo (STEP). Int Surg1989; 74: 205. Google Scholar 7 : Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin: Overview of results of randomized trials in general, orthopedic, and urologic surgery. N Engl J Med1988; 318: 1162. Google Scholar 8 : Prevention of venous thromboembolism. Chest2004; 126: 338S. Google Scholar 9 : The rate of bleeding complications after pharmacologic deep venous thrombosis prophylaxis: a systematic review of 33 randomized controlled trials. Arch Surg2006; 141: 790. Google Scholar 10 : FDA Public Health Advisory. Anesthesiology1998; 88: 27A. Google Scholar 11 : Low molecular weight heparin for the prevention of venous thromboembolism after abdominal surgery. Br J Surg2004; 91: 965. Google Scholar 12 : Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery. Lancet1993; 341: 259. Google Scholar 13 : Efficacy and safety of low-molecular weight heparin and standard unfractionated heparin for prophylaxis of postoperative venous thromboembolism: European multicenter trial. World J Surg1997; 21: 2. Google Scholar 14 : Comparison of a low molecular weight heparin and unfractionated heparin for the prevention of deep vein thrombosis in patients undergoing abdominal surgery. Br J Surg1988; 75: 1058. Google Scholar 15 : Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost2003; 90: 446. Google Scholar 16 : Incidence of thromboembolism after transurethral resection of the prostate. Scand J Urol Nephrol2002; 36: 119. Google Scholar 17 : The effect of prophylactic subcutaneous heparin on blood loss during and after transurethral prostatectomy. Br J Urol1982; 54: 164. Google Scholar 18 : Surgical hemorrhage in patients given subcutaneous heparin as prophylaxis against thromboembolism. Br Med J1978; 7: 1326. Google Scholar 19 : Minidose heparin in transurethral prostatectomy. Urology1983; 23: 251. Google Scholar 20 : Prevention, diagnosis, and treatment of venous thromboembolic complications of gynecologic surgery. Am J Obstet Gynecol2001; 184: 759. Google Scholar 21 : The efficacy of graduated compression stocking in the prevention of deep vein thrombosis after major gynecologic surgery. Br J Obstet Gynaecol1984; 91: 588. Google Scholar 22 : A randomized trial of low-dose heparin and intermittent pneumatic calf compression for the prevention of deep vein thrombosis after gynecologic oncology surgery. Am J Obstet Gynecol1993; 168: 1146. Google Scholar 23 : Pneumatic compression versus low molecular weight heparin in gynecologic oncology surgery: a randomized trial. Obstet Gyn2001; 98: 989. Google Scholar 24 : Comparison of low molecular weight heparin with sodium heparin for prophylaxis against postoperative thrombosis in women undergoing major gynecological surgery. Aust N Z J Obstet Gynaecol1998; 38: 91. Google Scholar 25 : Comparison of enoxaparin and standard heparin in gynecologic oncologic surgery: a randomized prospective double blind clinical study. Eur J Gynaecol Oncol2001; 22: 127. Google Scholar 26 : Laparoscopic nephrectomy: the experience of the laparoscopic working group of the German Urologic Association. J Urol1998; 160: 18. Link, Google Scholar 27 : Venous thrombosis prophylaxis for urologic laparoscopy: fractionated heparin versus sequential compression devices. J Urol2005; 173: 1623. Link, Google Scholar 28 : Multi-institutional study of symptomatic deep venous thrombosis and pulmonary embolism in prostate cancer patients undergoing laparoscopic or robot-assisted laparoscopic radical prostatectomy. Eur Urol2008; 53: 134. Google Scholar 29 : Thromboembolic complication rate after radical retropubic prostatectomy: Impact of routine ultrasonography for the detection of pelvic lymphocele and hematomas. Eur Urol1998; 33: 86. Google Scholar 30 : Radical retropubic prostatectomy: morbidity and quality of life experience with 620 consecutive cases. J Urol1992; 147: 883. Link, Google Scholar 31 : Thromboembolic complications following radical retropubic prostatectomy: Influence of external sequential compression devices. Urology1993; 42: 406. Google Scholar 32 : Early complications of contemporary anatomical radical retropubic prostatectomy. J Urol1994; 152: 1858. Link, Google Scholar 33 : Color Doppler flow imaging for deep venous thrombosis screening in patients undergoing pelvic lymphadenectomy and radical retropubic prostatectomy for prostatic carcinoma. J Urol1995; 153: 1866. Link, Google Scholar 34 : The diagnosis of deep vein thrombosis using the 125I fibrinogen test. Arch Surg1972; 104: 152. Google Scholar 35 : Venous thromboembolism in radical prostatectomy: is heparinoid prophylaxis warranted?. BJU Int2005; 96: 1019. Google Scholar 36 : Low molecular weight heparin and radical prostatectomy: a prospective analysis of safety and side effects. Prostate Cancer and Prostatic Diseases1997; 1: 101. Google Scholar 37 : Is heparin contraindicated in pelvic lymphadenectomy and radical prostatectomy?. J Urol1997; 158: 869. Link, Google Scholar 38 : Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol2001; 19: 666. Crossref, Medline, Google Scholar 39 : Radical cystectomy for carcinoma of the bladder: critical evaluation of the results in 1,026 cases. J Urol1997; 158: 393. Link, Google Scholar 40 : Radical cystectomy for elderly patients with bladder cancer: an updated experience with 404 patients. Cancer1998; 83: 141. Google Scholar 41 : Prospective analysis of pulmonary embolism in the postoperative patient. Surgery1970; 68: 116. Google Scholar 42 : Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol2002; 167: 2012. Link, Google Scholar 43 : Impact of a collaborative care approach to radical cystectomy and urinary reconstruction. J Urol1995; 154: 996. Link, Google Scholar American Urological Association Education and Research, Inc.© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited byHebert K, Matta R, Horns J, Paudel N, Das R, Kohler T, Pastuszak A, McCormick B, Hotaling J and Myers J (2022) Risk of Postoperative Thromboembolism in Men Undergoing Urological Prosthetic Surgery: An Assessment of 21,413 MenJournal of Urology, VOL. 208, NO. 4, (878-885), Online publication date: 1-Oct-2022.Cai T, Tandogdu Z, Wagenlehner F and Bjerklund Johansen T (2020) Re: COVID-19 Coagulopathy: Considerations for UrologistsJournal of Urology, VOL. 204, NO. 4, (848-849), Online publication date: 1-Oct-2020.Jue J and Alameddine M (2020) COVID-19 Coagulopathy: Considerations for UrologistsJournal of Urology, VOL. 204, NO. 4, (640-641), Online publication date: 1-Oct-2020.Chrouser K, Foley F, Goldenberg M, Hyder J, Maranchie J, Moore J, Semins M, Smith A, Stoffel J, Stroup S and Wilkinson G (2020) Optimizing Outcomes in Urological Surgery: Intraoperative Patient Safety and Physiological ConsiderationsUrology Practice, VOL. 7, NO. 4, (309-318), Online publication date: 1-Jul-2020.Klaassen Z, Arora K, Goldberg H, Chandrasekar T, Wallis C, Sayyid R, Fleshner N, Finelli A, Kutikov A, Violette P and Kulkarni G (2017) Extended Venous Thromboembolism Prophylaxis after Radical Cystectomy: A Call for Adherence to Current GuidelinesJournal of Urology, VOL. 199, NO. 4, (906-914), Online publication date: 1-Apr-2018.Kaplan S (2017) Re: Benign Prostatic Hyperplasia Implications for Pharmacologic Treatment and Perioperative CareJournal of Urology, VOL. 197, NO. 4, (1118-1120), Online publication date: 1-Apr-2017.Duivenvoorden W, Daneshmand S, Canter D, Lotan Y, Black P, Abdi H, van Rhijn B, Fransen van de Putte E, Zareba P, Koskinen I, Kassouf W, Traboulsi S, Kukreja J, Boström P, Shayegan B and Pinthus J (2016) Incidence, Characteristics and Implications of Thromboembolic Events in Patients with Muscle Invasive Urothelial Carcinoma of the Bladder Undergoing Neoadjuvant ChemotherapyJournal of Urology, VOL. 196, NO. 6, (1627-1633), Online publication date: 1-Dec-2016.Zaid H, Yang D, Tollefson M, Frank I, Parker W, Thompson R, Karnes R and Boorjian S (2016) Safety and Efficacy of Extended Duration of Thromboembolic Prophylaxis Following Radical Cystectomy: An Initial Institutional ExperienceUrology Practice, VOL. 3, NO. 6, (462-467), Online publication date: 1-Nov-2016.Dahm P, Sultan S, Mustafa R, Morgan R and Falck-Ytter Y (2015) Re: Anticoagulation and Antiplatelet Therapy in Urological Practice: ICUD/AUA Review PaperJournal of Urology, VOL. 194, NO. 4, (1168-1169), Online publication date: 1-Oct-2015.Sun A, Djaladat H, Schuckman A, Miranda G, Cai J and Daneshmand S (2014) Venous Thromboembolism Following Radical Cystectomy: Significant Predictors, Comparison of Different Anticoagulants and Timing of EventsJournal of Urology, VOL. 193, NO. 2, (565-569), Online publication date: 1-Feb-2015.Tollefson M, Karnes R, Rangel L, Carlson R and Boorjian S (2013) Blood Type, Lymphadenectomy and Blood Transfusion Predict Venous Thromboembolic Events Following Radical Prostatectomy with Pelvic LymphadenectomyJournal of Urology, VOL. 191, NO. 3, (646-651), Online publication date: 1-Mar-2014.Sterious S, Simhan J, Uzzo R, Gershman B, Li T, Devarajan K, Canter D, Walton J, Fogg R, Ginzburg S, Corcoran A, Smaldone M and Kutikov A (2013) Familiarity and Self-Reported Compliance with American Urological Association Best Practice Recommendations for Use of Thromboembolic Prophylaxis among American Urological Association MembersJournal of Urology, VOL. 190, NO. 3, (992-998), Online publication date: 1-Sep-2013. Volume 181Issue 3March 2009Page: 1170-1177 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordspulmonary embolismurological surgical proceduresvenous thrombosisintermittent pneumatic compression devicesheparinAcknowledgments and DisclaimersAUA Best Practice Statement for the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic SurgeryTable 4. Summary of VTE prophylaxis recommendationsLevel of riskProphylactic treatmentLow Risk•No prophylaxis other than early ambulationModerate Risk•Heparin 5000 units every 12 hours subcutaneous starting after surgery•OR⁎Enoxaparin 40 mg. (Cr Cl < 30 ml/min. = 30 mg.) subcutaneous daily•OR Pneumatic compression device if risk of bleeding is highHigh Risk•Heparin 5000 units every 8 hours subcutaneous starting after surgery•OR⁎Enoxaparin 40 mg. (Cr Cl < 30 ml/min. = 30 mg.) subcutaneous daily•OR Pneumatic compression device if risk of bleeding is highVery High Risk•⁎Enoxaparin 40 mg. (Cr Cl < 30 ml/min. = 30 mg.) subcutaneous daily and adjuvant pneumatic compression device, or•Heparin 5000 units every 8 hours subcutaneous starting after surgery and adjuvant pneumatic compression deviceIn selected very high-risk patients, clinicians should consider post-discharge Enoxaparin or Warfarin.Key: mg, milligram; Cr Cl, creatinine clearance; ml, milliliter; min, minute; Kg, kilogram⁎Guidelines and Cautions for Enoxaparin Use•In patients with a body weight > 150 Kg. consider increasing prophylaxis dose of Enoxaparin to 40 mg. subcutaneous every 12 hours.•Withhold Enoxaparin generally for at least 2 to 3 days after major trauma, and then only consider use after review of current patient condition and risk benefit ratio.•For planned manipulation of an epidural or spinal catheter (insertion, removal), Enoxaparin should be avoided/held for 24 hours BEFORE planned manipulation and should be resumed no earlier than 2 hours FOLLOWING manipulation.•Special testing may be indicated for Enoxaparin in a patient with a history of heparin-induced thrombocytopenia.•The risks of bleeding must be weighed against the benefits of prophylaxis in determining the timing of initiation of DVT pharmacologic prophylaxis in combination with mechanical prophylaxis.The supporting systematic literature review and the drafting of this document were conducted by the Prevention of Deep Vein Thrombosis in Patients Undergoing Urologic Surgery Panel (the Panel) created in 2006 by the AUA. The PGC of the AUA selected the Panel chair who in turn appointed the additional Panel members with specific expertise in this disease.The mission of the Panel was to develop either analysis- or consensus-based recommendations, depending on the type of evidence available and Panel processes, to support optimal clinical practices in the prevention of deep vein thrombosis in patients undergoing urologic surgery.This document was submitted to 23 urologists and other health care professionals for peer review. After revision of the document based upon the peer review comments, the guideline was submitted to and approved by the PGC and the BOD of the AUA. Funding of the Panel and of the PGC was provided by the AUA. Panel members received no remuneration for their work. Each member of the PGC and of the Panel furnished a current conflict of interest disclosure to the AUA.The final report is intended to provide medical practitioners with a current understanding of the principles and strategies for the prevention of deep vein thrombosis in patients undergoing urologic surgery. The report is based on review of available professional literature as well as clinical experience and expert opinion.This document provides guidance only and does not establish a fixed set of rules or define the legal standard of care. As medical knowledge expands and technology advances, this guideline will change. Today they represent not absolute mandates but provisional proposals or recommendations for treatment under the specific conditions described. For all these reasons, this best practice statement does not preempt physician judgment in individual cases. Also, treating physicians must take into account variations in resources, and in patient tolerances, needs and preferences. Conformance with the best practice statement reflected in this document cannot guarantee a successful outcome.MetricsAuthor Information John B. Forrest More articles by this author J. Quentin Clemens Financial interest and/or other relationship with Merck, Pfizer, Medtronics and Tengion, Inc. More articles by this author Peter Finamore More articles by this author Raymond Leveillee Financial interest and/or other relationship with Intuitive Surgical, Applied Medical and Angiodynamics, Covidien and Lumasense. More articles by this author Marguerite Lippert More articles by this author Louis Pisters Financial interest and/or other relationship with Endocare. More articles by this author Karim Touijer More articles by this author Kristine Whitmore Financial interest and/or other relationship with Ortho-McNeil, Astellas and Advanced Bionics. 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