Risk of thrombosis and bleeding in urological cancer surgery (ROTBUS Cancer): Series of systematic reviews and meta-analyses
BAUS ePoster online library. Tikkinen K. 06/29/16; 131985; P8-15 Disclosure(s): I have no financial conflicts of interest. I am chairman of the European Association of Urology (EAU) ad hoc guideline panel on Thromboprophylaxis, and member of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group.
Assoc. Prof. Kari Tikkinen
Assoc. Prof. Kari Tikkinen
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P8-15

INTRODUCTION: Pharmacological thromboprophylaxis involves trading off reduction in venous thromboembolism (VTE) against increased bleeding. Here we provide best estimates of absolute risk of VTE and bleeding in urological cancer surgery.

MATERIALS AND METHODS: We searched for contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. For each procedure we accounted for use of thromboprophylaxis, length of follow-up, and derived best estimates from the median of included studies. Primary endpoints were 4-week post-operative incidence of symptomatic VTE and bleeding requiring reoperation. We stratified on patient risk factors for VTE (BMI >35, age >75, personal or family history). Quality of evidence was assessed using GRADE.

RESULTS: We included 64 studies reporting on 13 urological cancer procedures, including different approaches of cystectomy, prostatectomy, and nephrectomy. Quality of evidence was moderate for prostatectomy and cystectomy and low or very low for renal procedures. Risk of VTE varied widely between procedures, and between approaches within the same procedure. Cystectomies were high risk for VTE (ranging 2.9%-13.9%) but low risk for bleeding (0.3%). Risks of VTE in prostatectomies showed substantial variation depending on patient risk factors and use of PLND (0.2%-15.7%), with bleeding risks from 0.2%-0.4%. VTE risks in renal cancer surgeries were between 0.7%-6.2% across patient risk groups, with bleeding risks of between 0.1%-1.7%.

CONCLUSIONS: Our results suggest that extended thromboprophylaxis is clearly warranted in some procedures. For those operations where the tradeoff is less clear, the decision will depend on surgeon and patient values and preferences with regard to VTE and bleeding.

P8-15

INTRODUCTION: Pharmacological thromboprophylaxis involves trading off reduction in venous thromboembolism (VTE) against increased bleeding. Here we provide best estimates of absolute risk of VTE and bleeding in urological cancer surgery.

MATERIALS AND METHODS: We searched for contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. For each procedure we accounted for use of thromboprophylaxis, length of follow-up, and derived best estimates from the median of included studies. Primary endpoints were 4-week post-operative incidence of symptomatic VTE and bleeding requiring reoperation. We stratified on patient risk factors for VTE (BMI >35, age >75, personal or family history). Quality of evidence was assessed using GRADE.

RESULTS: We included 64 studies reporting on 13 urological cancer procedures, including different approaches of cystectomy, prostatectomy, and nephrectomy. Quality of evidence was moderate for prostatectomy and cystectomy and low or very low for renal procedures. Risk of VTE varied widely between procedures, and between approaches within the same procedure. Cystectomies were high risk for VTE (ranging 2.9%-13.9%) but low risk for bleeding (0.3%). Risks of VTE in prostatectomies showed substantial variation depending on patient risk factors and use of PLND (0.2%-15.7%), with bleeding risks from 0.2%-0.4%. VTE risks in renal cancer surgeries were between 0.7%-6.2% across patient risk groups, with bleeding risks of between 0.1%-1.7%.

CONCLUSIONS: Our results suggest that extended thromboprophylaxis is clearly warranted in some procedures. For those operations where the tradeoff is less clear, the decision will depend on surgeon and patient values and preferences with regard to VTE and bleeding.

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