Oncology - Bladder, Renal, Test
Mid-Atlantic Section 76th Annual Meeting
Introduction & Objective : Radical cystectomy (RC) with urinary diversion performed for bladder cancer is associated with a significant rate of venous thromboembolic events (VTE). While VTE prophylaxis is recommended, there is lack of agreement regarding optimal protocols. We sought to determine the VTE risk reduction associated with each iteration of our VTE protocol.
Methods : We retrospectively reviewed our RC experience between 2006 and 2018. We assessed the prevalence of VTE risk factors in our RC population, and documented the evolution of our VTE prophylaxis protocols.
297 patients underwent RC. Results are summarized in Table 1. 163 received anticoagulation (AC) only while hospitalized (Group A). 59 received AC while hospitalized and for 3-4 weeks post-discharge (Group B). 75 received AC prior to RC and for 3-4 weeks post-RC with focused teaching on the importance of compliance with early ambulation and AC use (Group C). When comparing Groups B and C with group A, only Group C demonstrated a significant decrease in VTE events (p=0.04), although the trend was for decreasing VTE incidence with increasingly aggressive prophylaxis across all three groups (15% vs 10% vs 5%). Further comparing Groups A and C, smoking was more prevalent in Group A (85% vs 71%, p=0.01) and more lymph nodes were harvested in Group C (p=0.01), reflecting evolving practice patterns within our group (Table 1). There were no other statistically significant differences in the incidence of known VTE risk factors between groups. VTE prophylaxis, lymph node yield, and smoking were not independent predictors of VTE rates in a multivariable model.
Conclusions : Institution of an aggressive VTE prophylaxis program is associated with diminished VTE rates with no evidence of increased bleeding complications. However, VTE prophylaxis program is not shown to be an independent predictor of VTE rate on multivariable analysis, possibly because of changes in smoking incidence in the population that occurred concurrently with changes in VTE prevention protocols.