Introduction: With an incidence of about 5%, Factor V Leiden is the most common hereditary hypercoagulability among Caucasians. The increased risk of thromboembolic events is 5 to 8 fold in heterozygous and 10 to 25 fold in homozygous patients. In general, perioperative anticoagulation needs to be individualized, especially in oncological patients in whom pelvic surgery is planned. It is unknown if factor V Leiden patients may be at higher risk of thromboembolic events when treated with radical prostatectomy.
Methods: Within our prospectively collected database, we analyzed 30,871 prostate cancer patients treated with radical prostatectomy between 2001 and 2019. Of those, patients with factor V Leiden were identified. All patients received individualized recommendation of hemostaseologists for perioperative anticoagulation. Thromboembolic complications (deep vein thrombosis, pulmonary embolism) were assessed during hospital stay, as well as according to patient reported outcomes within the first three months after radical prostatectomy.
Results: Overall, 77 (0.3%) patients with known factor V Leiden were identified. Median age was 64 years (interquartile range: 61-68 years). Median follow-up was 37 months (IQR: 8-60 months). Within all 77 patients with factor V Leiden, none experienced thromboembolic complications within the first three months after surgery.
Conclusions: In our cohort of patients with factor V Leiden, no thromboembolic events were observed after radical prostatectomy with individualized anticoagulation. This may reassure patients with this hereditary condition who are counselled for radical prostatectomy. Source of