Late venous thromboembolic disease after radical prostatectomy: effect of risk factors, warfarin and early discharge.
OBJECTIVE
We determined the incidence of late venous thromboembolic disease after radical prostatectomy, and the influence of risk factors, length of hospital stay and warfarin anticoagulation.


METHODS
Patients undergoing radical prostatectomy received routine deep vein thrombosis prophylaxis that consisted of intermittent pneumatic compression stockings, early ambulation and warfarin administration during hospitalization with the goal of achieving a prothrombin time international normalized ratio of 1.5 or greater. When patients returned to the hospital for postoperative evaluation, venous duplex ultrasonography of the lower extremities was done. All patients were contacted at 2 months to ensure that they did not suffer a clinical thromboembolic event.


RESULTS
One of 158 patients consenting to the study had a symptomatic thromboembolic event for a clinical incidence of 0.6% (95% confidence interval 0.0 to 3.5). Duplex ultrasonography was performed 21.4 +/- 7.8 days postoperatively and 3 of the 106 patients who completed the study had a positive ultrasound for an incidence of 2.8% (95% confidence interval 0.6 to 8.1). None of these patients suffered a symptomatic thromboembolic event. Age, body mass index, length of hospital stay, operative time, estimated blood loss, prostate specific antigen and Gleason score were evaluated for a statistical relationship with thromboembolic events. Only higher body mass index and length of hospitalization approached statistical significance.


CONCLUSIONS
Late deep vein thrombosis can occur after radical retropubic prostatectomy. Shorter prophylaxis period, secondary to shorter periods of hospitalization, did not increase the risk of thromboembolic events. The combination of intermittent pneumatic compression stockings and warfarin anticoagulation may be contributing to the relatively low deep vein thrombosis rate in our study compared to previous studies.
Kibel
A S
AS
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Creager
M A
MA
Goldhaber
S Z
SZ
Richie
J P
JP
Loughlin
K R
KR
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin