Schomburg John, Krishna Suprita, Soubra Ayman, Cotter Katherine, Fan Yunhua, Brown Graham, Konety Badrinath
Department of Urology, University of Minnesota, Minneapolis, MN.
Department of Urology, University of Minnesota, Minneapolis, MN.
Urol Oncol. 2018 Feb;36(2):77.e9-77.e13. doi: 10.1016/j.urolonc.2017.09.029. Epub 2017 Oct 31.
Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism, is a common cause of morbidity and mortality after radical cystectomy. The purpose of our study was to evaluate the utility of extended outpatient chemoprophylaxis against VTE after radical cystectomy-with a focus on any reduction in the incidence of VTE, including DVT and pulmonary embolism.
Beginning in April 2013, we prospectively instituted a policy of extending inpatient VTE prophylaxis with subcutaneous heparin/enoxaparin for 30 days postoperatively. For this study, we reviewed the electronic medical records of all patients who underwent radical cystectomy at our institution from January 2012 through December 2015. The experimental group (n = 79) received extended outpatient chemoprophylaxis against VTE; the control group (n = 51) received no chemoprophylaxis after discharge. The primary outcome was the 90-day incidence of VTE. The secondary outcomes included the overall complication rate, the hemorrhagic complication rate, as well as the rate of readmission within 30 days of hospital discharge.
The experimental group experienced a significantly lower rate of DVT (5.06%), assessed as of 90 days postoperatively, than the control group (17.6%): a relative risk reduction of 71.3% (P = 0.021). We found no significant differences in secondary outcomes between the 2 groups, including the overall complication rate (54.4% vs. 68.6%), the hemorrhagic complication rate (3.7% vs. 2.0%), and the readmission rate (21.5% vs. 29.4%).
Extended outpatient chemoprophylaxis significantly reduced the incidence of VTE.
静脉血栓栓塞症（VTE），包括深静脉血栓形成（DVT）和肺栓塞，是根治性膀胱切除术后发病和死亡的常见原因。我们研究的目的是评估根治性膀胱切除术后延长门诊化学预防VTE的效用——重点关注VTE（包括DVT和肺栓塞）发病率的任何降低情况。
从2013年4月开始，我们前瞻性地制定了一项政策，即术后用皮下肝素/依诺肝素将住院患者VTE预防延长30天。对于本研究，我们回顾了2012年1月至2015年12月在我们机构接受根治性膀胱切除术的所有患者的电子病历。实验组（n = 79）接受延长门诊化学预防VTE；对照组（n = 51）出院后不接受化学预防。主要结局是VTE的90天发病率。次要结局包括总体并发症发生率、出血性并发症发生率以及出院后30天内的再入院率。
术后90天评估，实验组的DVT发生率（5.06%）显著低于对照组（17.6%）：相对风险降低71.3%（P = 0.021）。我们发现两组在次要结局方面无显著差异，包括总体并发症发生率（54.4%对68.6%）、出血性并发症发生率（3.7%对2.0%）和再入院率（21.5%对29.4%）。
延长门诊化学预防可显著降低VTE的发生率。
