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• W2079896585 abstract "No AccessJournal of UrologyAdult Urology1 Feb 2015Venous Thromboembolism Following Radical Cystectomy: Significant Predictors, Comparison of Different Anticoagulants and Timing of Events Andrew J. Sun, Hooman Djaladat, Anne Schuckman, Gus Miranda, Jie Cai, and Siamak Daneshmand Andrew J. SunAndrew J. Sun More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , and Siamak DaneshmandSiamak Daneshmand Financial interest and/or other relationship with Endo and Cubist. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.08.085AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We determined the rate, timing and predictors of venous thromboembolism after open radical cystectomy for urothelial bladder cancer. We also compared the use of warfarin (1971 to 2008) and unfractionated heparin (2008 to 2012) as prophylaxis. Materials and Methods: We retrospectively reviewed the records of 2,316 patients who underwent open radical cystectomy and extended pelvic lymph node dissection for urothelial bladder cancer with intent to cure at our institution between 1971 and 2012. The rate and timing of symptomatic venous thromboembolism that developed within 3 months of surgery was calculated in the cohort. Multivariate stepwise logistic regression was used to find significant predictors of symptomatic venous thromboembolism and compare the warfarin based and heparin based prophylaxis protocols. Results: A total of 109 symptomatic venous thromboembolism cases developed for a rate of 4.7%, including 2.1% for deep vein thrombosis and 2.6% for pulmonary embolism. Of these cases 57.8% developed after discharge home at a median of 20 days postoperatively (range 2 to 91). Four significant predictors of venous thromboembolism were identified, including body mass index (p = 0.0015), surgical margins (p = 0.025), diversion type (p = 0.023) and hospitalization duration (p <0.0001). Use of prophylactic heparin vs warfarin was not a significant predictor (p = 0.31). Conclusions: Venous thromboembolism remains a significant complication of open radical cystectomy. Using an in-house, heparin based anticoagulation protocol consistent with current AUA (American Urological Association) guidelines has not decreased the rate of venous thromboembolism compared to historical warfarin use. On closer evaluation most venous thromboembolism cases in our population occurred after discharge home. Future studies are needed to establish the benefits of extended duration venous thromboembolism prophylaxis regimens that cover the critical post-hospitalization period. References 1 : The value of family history as a risk indicator for venous thrombosis. Arch Intern Med2009; 169: 610. Google Scholar 2 : Congenital thrombophilic states associated with venous thrombosis: a qualitative overview and proposed classification system. Ann Intern Med2003; 138: 128. Google Scholar 3 : Bilateral vs. ipsilateral venography as the primary efficacy outcome measure in thromboprophylaxis clinical trials: a systematic review. J Thromb Haemost2004; 2: 1752. 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Google Scholar © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKlaassen 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.Pariser J, Pearce S, Anderson B, Packiam V, Prachand V, Smith N and Steinberg G (2016) Extended Duration Enoxaparin Decreases the Rate of Venous Thromboembolic Events after Radical Cystectomy Compared to Inpatient Only Subcutaneous HeparinJournal of Urology, VOL. 197, NO. 2, (302-307), Online publication date: 1-Feb-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. Volume 193Issue 2February 2015Page: 565-569 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.Keywordsvenous thromboembolismurinary bladder neoplasmspostoperative complicationscystectomyanticoagulantsMetricsAuthor Information Andrew J. Sun More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Siamak Daneshmand Financial interest and/or other relationship with Endo and Cubist. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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