Thromboprophylaxis in radical retropubic prostatectomy: efficacy and patient compliance of a dual modality.
OBJECTIVE
The risk of developing venous thromboembolism (VTE) in urologic patients undergoing major surgery without thromboprophylaxis is high (up to 40%). The aims were to study the acceptability rate of and overall patient satisfaction with an automatic sequential leg compression system and the short-term effectiveness of a combined VTE prevention modality.


METHODS
One-hundred and eighty-four consecutive patients undergoing radical retropubic prostatectomy were postoperatively treated with enoxaparine and intermittent pneumatic compression of the thigh. By completing a questionnaire, the patients were prospectively studied to evaluate the comfort and tolerability of a compression device (SCD Response Compression System; Covidien, Gosport, UK). The patients were monitored for complications and development of VTE for up to 4 weeks postoperatively. The device used ensures customized and effective compression therapy matching the patient's individual vascular refill by sequential, gradient, circumferential microprocessor-controlled compression cycles.


RESULTS
No clinically evident VTE, critical bleeding or postoperative death occurred during the study period. Drain output was associated with transfusion requirement (p < 0.001), obesity (p < 0.02) and longer operation duration (p < 0.001). The sequential compression devices were well tolerated by 63% of the patients, in that the sleeves were judged as being pleasant (72%) and nonoppressive (79%). Patients reported bothersome insomnia (23%) and noise (44%), and early removal was required in 3%.


CONCLUSIONS
Combined mechanical and pharmacological thromboprophylaxis was highly effective, well tolerated, and safe. The device tested showed a high comfort and tolerability profile. The use of combined modalities for VTE prophylaxis is justified in patients at very high risk of VTE, such as those undergoing radical retropubic prostatectomy.
Cindolo
Luca
L
Urology Unit, G Rummo Hospital, Benevento, Italy. lucacindolo@virgilio.it
Salzano
Luigi
L
Mirone
Vincenzo
V
Imbimbo
Ciro
C
Longo
Nicola
N
Kakkos
Stavros K
SK
Reddy
Daniel J
DJ
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D017984:Enoxaparin / Q000627:therapeutic use*; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D010349:Patient Compliance; D011468:Prostatectomy / Q000009:adverse effects*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D017984:Enoxaparin