Zaid Harras B, Yang David Y, Tollefson Matthew K, Frank Igor, Parker William P, Thompson R Houston, Karnes R Jeffrey, Boorjian Stephen A
Department of Urology, Mayo Clinic, Rochester, Minnesota.
Urol Pract. 2016 Nov;3(6):462-467. doi: 10.1016/j.urpr.2016.01.002. Epub 2016 Aug 18.
We evaluated the safety and efficacy of extended duration of pharmacological prophylaxis for preventing symptomatic venous thromboembolism following radical cystectomy.
We recorded symptomatic venous thromboembolism and lymphocele events within 30 days of radical cystectomy among patients treated with extended duration of pharmacological prophylaxis (enoxaparin 40 mg subcutaneously daily for 30 days). We compared these outcomes to those in the cohort of patients who underwent radical cystectomy at our institution in the year prior to extended prophylaxis implementation. Unadjusted descriptive statistics and univariate analyses were performed using the Pearson test or the Fisher chi-square test for categorical variables and the Wilcoxon rank sum test for continuous variables.
We analyzed the records of 52 patients who did and 82 who did not receive extended duration of pharmacological prophylaxis after radical cystectomy. Only 1 patient (1.9%) discharged home on extended prophylaxis was diagnosed with venous thromboembolism within 30 days of RC compared to 5 (6.1%) who had not received extended prophylaxis. In 3 patients symptomatic lymphocele developed within 30 days of radical cystectomy, including 1 (1.9%) who had received extended prophylaxis and 2 (2.4%) who had not. No patient in either cohort was rehospitalized for bleeding complications.
Our initial experience suggests that extended duration of pharmacological prophylaxis is associated with a lower rate of venous thromboembolism following radical cystectomy and it does not increase the risk of bleeding or symptomatic lymphocele. These data warrant validation in larger patient cohorts, ideally in the prospective clinical trial setting.
我们评估了延长药物预防时间对根治性膀胱切除术后预防有症状静脉血栓栓塞的安全性和有效性。
我们记录了接受延长药物预防（依诺肝素40mg皮下注射，每日1次，共30天）的患者在根治性膀胱切除术后30天内发生的有症状静脉血栓栓塞和淋巴囊肿事件。我们将这些结果与在实施延长预防措施前一年在我们机构接受根治性膀胱切除术的患者队列的结果进行了比较。使用Pearson检验或Fisher卡方检验对分类变量进行未调整的描述性统计和单变量分析，对连续变量进行Wilcoxon秩和检验。
我们分析了52例接受根治性膀胱切除术后接受延长药物预防的患者和82例未接受延长药物预防的患者的记录。在接受延长预防措施出院回家的患者中，只有1例（1.9%）在根治性膀胱切除术后30天内被诊断为静脉血栓栓塞，而未接受延长预防措施的患者中有5例（6.1%）。在3例患者中，根治性膀胱切除术后30天内出现有症状的淋巴囊肿，其中1例（1.9%）接受了延长预防措施，2例（2.4%）未接受延长预防措施。两个队列中均无患者因出血并发症再次住院。
我们的初步经验表明，延长药物预防时间与根治性膀胱切除术后静脉血栓栓塞发生率较低相关，且不会增加出血或有症状淋巴囊肿的风险。这些数据需要在更大的患者队列中进行验证，理想情况下是在前瞻性临床试验中进行验证。
