MP22-13 HOW SAFE IS EXTENDED PHARMACOLOGICAL VENOUS THROMBOEMBOLISM PROPHYLAXIS (EPVTEP) FOR PATIENT UNDERGOING RADICAL CYSTECTOMY? (2014)

You have accessJournal of UrologyBladder Cancer: Detection & Screening1 Apr 2014MP22-13 HOW SAFE IS EXTENDED PHARMACOLOGICAL VENOUS THROMBOEMBOLISM PROPHYLAXIS (EPVTEP) FOR PATIENT UNDERGOING RADICAL CYSTECTOMY? Reza Mehrazin, Zachary Piotrowski, Brian Egleston, Daniel Parker, Jeffrey J. Tomaszewski, Marc C. Smaldone, Paul Bloch, Kevan Iffrig, Philip Abbosh, Timothy Ito, Rosalia Viterbo, Richard E. Greenberg, David Y.T. Chen, Robert G. Uzzo, and Alexander Kutikov Reza MehrazinReza Mehrazin More articles by this author , Zachary PiotrowskiZachary Piotrowski More articles by this author , Brian EglestonBrian Egleston More articles by this author , Daniel ParkerDaniel Parker More articles by this author , Jeffrey J. TomaszewskiJeffrey J. Tomaszewski More articles by this author , Marc C. SmaldoneMarc C. Smaldone More articles by this author , Paul BlochPaul Bloch More articles by this author , Kevan IffrigKevan Iffrig More articles by this author , Philip AbboshPhilip Abbosh More articles by this author , Timothy ItoTimothy Ito More articles by this author , Rosalia ViterboRosalia Viterbo More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , David Y.T. ChenDavid Y.T. Chen More articles by this author , Robert G. UzzoRobert G. Uzzo More articles by this author , and Alexander KutikovAlexander Kutikov More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current National Comprehensive Cancer Network and United Kingdom National Institute for Health and Clinical Excellence guidelines recommend EPVTEP of 4 weeks duration following pelvic surgery, including radical cystectomy (RC); however, this policy has not been validated. Importantly, low molecular weight heparin (LMWH) is renally cleared, and patients with GFR < 30 risk bioaccumulation and potential for hemorrhagic complications. Since RC patients often experience dehydration and secondary renal insufficiency, we sought to quantitate the risk of clinically significant renal function deterioration following RC, which could result in supratherapeutic levels of LMWH. METHODS Patients undergoing RC between 2006 and 2011 were identified from the institutional registry. GFR was calculated based on the MDRD formula and categorized as: preoperative, discharge, and nadir (lowest GFR within 90 days of discharge). Patient perioperative GFR trends in patients who would have been candidates for EPVTEP were evaluated. RESULTS 308 patients with GFR > 30 ml/min/1.73m2 at the time of hospital discharge were included in the analysis as potentially eligible for EPVTEP. Most patients were Caucasian (90%), male (73%), with a median age of 69 years old. Readmission rate for the entire cohort was 32%. Nearly half (43%) of patients exhibited decline in GFR following discharge, with the average percent drop being 14.3%. Importantly, 13.0% of patients (n=40), who would have qualified for EPVTEP at discharge, experienced nadir GRF below the 30 ml/min/1.73m2 threshold where LMWH would have become supratherapeutic (Table). CONCLUSIONS A large portion of patients (43%) undergoing RC experience GFR decline following discharge. In our cohort, 13% of candidates for EPVTEP, including those with discharge GFR >60, had a GFR decline such that LMWH, had it been given as per current recommendations, potentially would have become supratherapeutic and risked clinically significant bleeding. While post-operative VTE following RC is a recognized concern, a better understanding of risks of EPVTEP is needed before this strategy is universally adopted in patients undergoing RC. n (% of total) Patients with Nadir GFR < 30 ml/min/1.73m2 (% of group) All patients 308 (100%) 40 (13%) Patients with discharge GFR > 60 ml/min/1.73m2 231 (75%) 14 (6%) Patients with discharge GFR 40-60 ml/min/1.73m2 62 (20%) 20 (32%) Patients with discharge GFR 30-40 ml/min/1.73m2 15 (5%) 6 (40%) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e239 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Reza Mehrazin More articles by this author Zachary Piotrowski More articles by this author Brian Egleston More articles by this author Daniel Parker More articles by this author Jeffrey J. Tomaszewski More articles by this author Marc C. Smaldone More articles by this author Paul Bloch More articles by this author Kevan Iffrig More articles by this author Philip Abbosh More articles by this author Timothy Ito More articles by this author Rosalia Viterbo More articles by this author Richard E. Greenberg More articles by this author David Y.T. Chen More articles by this author Robert G. Uzzo More articles by this author Alexander Kutikov More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...