title: Venous thromboembolism in urologic surgery: prophylaxis, diagnosis, and treatment.
abstract: Venous thromboembolism (VTE) represents one of the most common and potentially devastating complications of urologic surgery. With VTE's rapid onset of symptoms, association with a precipitous clinical course, and high mortality rate, all urologists should be well versed in appropriate prophylaxis, prompt diagnosis, and expeditious treatment. A MEDLINE(R) search was performed for articles that examined the incidence, diagnosis, and treatment of VTE in urologic surgery. Additional articles were reviewed based on cited references. There is a paucity of prospective studies on VTE in the urologic literature with most recommendations for urologic surgery patients being extrapolated from other surgical disciplines. Retrospective studies place VTE incidence rates in major urologic surgeries among the highest reported-highlighting the importance of thromboprophylaxis. Conversely, VTE was rarely reported in association with endoscopic and laparoscopic procedures making mechanical thromboprophylaxis sufficient. Recent literature reveals delayed VTE occurring after hospital discharge to be a persistent threat despite inpatient preoperative prophylaxis. Computed tomographic angiography has emerged as the test of choice for diagnosing pulmonary embolism, whereas lower extremity duplex sonography is recommended for diagnosing deep venous thrombosis. Traditional angiography is rarely used. Treatment of VTE involves therapeutic anticoagulation for various lengths of time based on presence and reversibility of patient risk factors as well as number of events. Perioperative thromboprophylaxis should be considered in all major urologic surgeries. Urologists should be familiar with incidence rates, recommended prophylaxis, appropriate diagnosis, and treatment recommendations for VTE to minimize morbidity and mortality. The limited number of prospective, randomized, controlled trials evaluating the use of thromboprophylaxis in urologic surgery demonstrates the need for further research.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Rice
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Brassell
authors.forename: David G
authors.initials: DG
authors.lastname: McLeod
references.citation: Lancet. 1959 Dec 5;2(7110):981-9
references.pmid: 14445257
references.citation: Thromb Res. 1995 Dec 15;80(6):491-7
references.pmid: 8610277
references.citation: J Urol. 1989 Dec;142(6):1403-11
references.pmid: 2685359
references.citation: Am J Cardiol. 2000 Oct 1;86(7):807-9, A10
references.pmid: 11018210
references.citation: Am J Med. 2004 Nov 1;117(9):676-84
references.pmid: 15501206
references.citation: Ann Intern Med. 1993 Nov 1;119(9):874-81
references.pmid: 8214998
references.citation: Ann Intern Med. 1997 May 15;126(10):775-81
references.pmid: 9148650
references.citation: Eur Heart J. 2000 Aug;21(16):1301-36
references.pmid: 10952823
references.citation: BMJ. 1994 Jan 22;308(6923):235-46
references.pmid: 8054013
references.citation: Urology. 1993 Oct;42(4):406-8
references.pmid: 8212439
references.citation: Eur Urol. 2007 Jan;51(1):130-5; discussion 136
references.pmid: 16942832
references.citation: Thromb Haemost. 1997 Jul;78(1):117-20
references.pmid: 9198139
references.citation: J Urol. 1995 Jun;153(6):1763-74
references.pmid: 7538597
references.citation: Thromb Res. 2001 May 15;102(4):295-309
references.pmid: 11369423
references.citation: Urology. 1994 Feb;43(2 Suppl):47-51
references.pmid: 8116133
references.citation: Arch Intern Med. 2002 Jun 10;162(11):1245-8
references.pmid: 12038942
references.citation: Chest. 2001 Jan;119(1 Suppl):132S-175S
references.pmid: 11157647
references.citation: Br J Surg. 1993 Jun;80(6):689-704
references.pmid: 7687188
references.citation: Lancet. 1975 Jul 12;2(7924):45-51
references.pmid: 49649
references.citation: Urol Clin North Am. 2001 Aug;28(3):639-53
references.pmid: 11590819
references.citation: Arch Intern Med. 1989 Nov;149(11):2549-55
references.pmid: 2818113
references.citation: J Urol. 2005 May;173(5):1623-6
references.pmid: 15821517
references.citation: Circulation. 2003 Jun 17;107(23 Suppl 1):I17-21
references.pmid: 12814981
references.citation: Urology. 1992 Apr;39(4):309-13
references.pmid: 1557840
references.citation: Thromb Haemost. 2003 Feb;89(2):221-7
references.pmid: 12574799
references.citation: Ann Intern Med. 1991 Feb 15;114(4):300-6
references.pmid: 1824813
references.citation: J Clin Oncol. 1991 Feb;9(2):286-94
references.pmid: 1988575
references.citation: Ann Surg. 1988 Aug;208(2):227-40
references.pmid: 2456748
references.citation: Br Med J. 1980 Feb 23;280(6213):514-7
references.pmid: 6989432
references.citation: J Urol. 1992 Mar;147(3 Pt 2):883-7
references.pmid: 1538489
references.citation: Lancet. 1992 Oct 10;340(8824):873-6
references.pmid: 1357297
references.citation: Lancet. 2000 Apr 15;355(9212):1295-302
references.pmid: 10776741
references.citation: Circulation. 1996 Jan 1;93(1):80-4
references.pmid: 8616946
references.citation: JAMA. 1976 May 3;235(18):1980-2
references.pmid: 946507
references.citation: Chest. 2004 Sep;126(3 Suppl):338S-400S
references.pmid: 15383478
references.citation: Lancet. 1993 Jan 30;341(8840):259-65
references.pmid: 8093915
references.citation: J Urol. 1997 May;157(5):1774-6
references.pmid: 9112525
references.citation: Lancet. 1992 Jul 18;340(8812):152-6
references.pmid: 1352573
references.citation: N Engl J Med. 1986 Oct 30;315(18):1109-14
references.pmid: 3531862
references.citation: Arch Intern Med. 1989 Apr;149(4):771-4
references.pmid: 2650646
references.citation: Arch Intern Med. 1999 Mar 8;159(5):445-53
references.pmid: 10074952
references.citation: JAMA. 1977 Dec 5;238(23):2509-11
references.pmid: 578884
references.citation: Urol Clin North Am. 1983 Feb;10(1):101-8
references.pmid: 6188264
references.citation: Thromb Haemost. 2003 Feb;89(2):228-34
references.pmid: 12574800
references.citation: J Urol. 1994 Nov;152(5 Pt 2):1850-7
references.pmid: 7523733
references.citation: N Engl J Med. 2002 Mar 28;346(13):975-80
references.pmid: 11919306
references.citation: J Clin Oncol. 1990 Jun;8(6):1005-18
references.pmid: 2189950
references.citation: Br J Surg. 1997 Jun;84(6):750-9
references.pmid: 9189079
references.citation: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD001100
references.pmid: 15495007
references.citation: Medicine (Baltimore). 1999 Sep;78(5):285-91
references.pmid: 10499070
references.citation: J Urol. 1994 Nov;152(5 Pt 2):1858-60
references.pmid: 7933241
references.citation: Am J Med. 1990 Jul;89(1):25-8
references.pmid: 2368789
references.citation: Eur Urol. 1999;35(3):210-6
references.pmid: 10072622
references.citation: Thromb Haemost. 2003 Sep;90(3):446-55
references.pmid: 12958614
references.citation: Pharmacol Rev. 1994 Mar;46(1):89-109
references.pmid: 8190751
references.citation: Ann Intern Med. 1982 May;96(5):561-5
references.pmid: 7073148
references.citation: Cancer. 1984 Oct 1;54(7):1264-8
references.pmid: 6547874
references.citation: Br J Surg. 2001 Jul;88(7):913-30
references.pmid: 11442521
references.citation: J Urol. 1995 Jun;153(6):1866-9
references.pmid: 7752335
references.citation: Ann Intern Med. 1997 Mar 15;126(6):454-7
references.pmid: 9072931
references.citation: J Urol. 2009 Mar;181(3):1170-7
references.pmid: 19152926
references.citation: J Urol. 1981 Mar;125(3):353-6
references.pmid: 7206085
references.citation: Thromb Haemost. 1996 Feb;75(2):251-3
references.pmid: 8815570
references.citation: J Clin Oncol. 1988 Feb;6(2):276-81
references.pmid: 2963094
references.citation: Arch Intern Med. 1992 Aug;152(8):1660-4
references.pmid: 1497399
references.citation: N Engl J Med. 2006 Jun 1;354(22):2317-27
references.pmid: 16738268
references.citation: Br J Haematol. 1980 Feb;44(2):173-82
references.pmid: 6990959
references.citation: Radiology. 1993 Mar;186(3):619-30
references.pmid: 8430164
references.citation: J Bone Joint Surg Br. 2006 Mar;88(3):386-91
references.pmid: 16498018
references.citation: JAMA. 1990 May 23-30;263(20):2753-9
references.pmid: 2332918
references.citation: Thromb Haemost. 1997 Jul;78(1):121-5
references.pmid: 9198140
references.citation: J Am Coll Cardiol. 2003 May 7;41(9):1633-52
references.pmid: 12742309
references.citation: Oncology (Williston Park). 1995 May;9(5):379-82; discussion 382, 385-6, 389
references.pmid: 7547200
references.citation: Br Med J. 1975 Nov 1;4(5991):257-9
references.pmid: 1104060
references.citation: BJU Int. 2005 Nov;96(7):1019-21
references.pmid: 16225520
references.citation: Chest. 2004 Sep;126(3 Suppl):188S-203S
references.pmid: 15383472
references.citation: J Urol. 1994 Apr;151(4):866-8
references.pmid: 8126812
references.citation: Urology. 1986 Jul;28(1):21-5
references.pmid: 3727224
references.citation: Br J Haematol. 2001 Aug;114(2):258-70
references.pmid: 11529843
references.citation: Lancet. 1995 May 27;345(8961):1326-30
references.pmid: 7752753
references.citation: Blood. 2005 Oct 15;106(8):2710-5
references.pmid: 15985543
references.citation: Thromb Haemost. 2002 Apr;87(4):575-9
references.pmid: 12008937
references.citation: Urology. 1981 Jan;17(1):39-43
references.pmid: 7456196
references.citation: J Bone Joint Surg Am. 1996 Jun;78(6):826-34
references.pmid: 8666599
references.citation: J Emerg Med. 1988 Jul-Aug;6(4):301-7
references.pmid: 3225435
references.citation: J Clin Oncol. 1994 Oct;12(10):2078-85
references.pmid: 7931477
references.citation: J Urol. 1997 May;157(5):1760-7
references.pmid: 9112522
references.citation: JAMA. 2007 Dec 19;298(23):2743-53
references.pmid: 18165667
references.citation: Chest. 2004 Sep;126(3 Suppl):401S-428S
references.pmid: 15383479
references.citation: Ann Intern Med. 1990 Mar 15;112(6):423-8
references.pmid: 2178534
references.citation: Eur Urol. 2008 Jan;53(1):134-45
references.pmid: 17597288
references.citation: Arch Intern Med. 1997 Feb 10;157(3):298-303
references.pmid: 9040296
references.citation: Am J Respir Crit Care Med. 1999 Sep;160(3):1043-66
references.pmid: 10471639
references.citation: Scand J Urol Nephrol. 2002;36(2):119-23
references.pmid: 12028685
references.citation: N Engl J Med. 1995 Jun 22;332(25):1661-5
references.pmid: 7760866
references.citation: Eur Respir J. 2005 May;25(5):843-8
references.pmid: 15863641
references.citation: BMJ. 1991 Mar 23;302(6778):709-11
references.pmid: 2021744
references.citation: Urology. 2006 Nov;68(5):988-92
references.pmid: 17113889
references.citation: Thromb Haemost. 1997 Dec;78(6):1422-5
references.pmid: 9423787
references.citation: Br J Surg. 1991 Jul;78(7):849-52
references.pmid: 1873716
references.citation: Ann Intern Med. 2004 Jun 15;140(12):985-91
references.pmid: 15197015
references.citation: Arch Intern Med. 1991 May;151(5):933-8
references.pmid: 2025141
references.citation: Thromb Haemost. 1999 Aug;82(2):610-9
references.pmid: 10605758
references.citation: Chest. 1996 Jan;109(1):78-81
references.pmid: 8549223
references.citation: Value Health. 1999 Jul-Aug;2(4):288-94
references.pmid: 16674319
references.citation: Prog Cardiovasc Dis. 1994 May-Jun;36(6):417-22
references.pmid: 8184095
references.citation: N Engl J Med. 1988 May 5;318(18):1162-73
references.pmid: 3283548
references.citation: Chest. 1997 Mar;111(3):537-43
references.pmid: 9118684
references.citation: Chest. 2001 Jan;119(1 Suppl):39S-63S
references.pmid: 11157642
references.citation: J Urol. 1999 Aug;162(2):433-8
references.pmid: 10411052
references.citation: BJU Int. 2000 Mar;85(4):427-30
references.pmid: 10691819
references.citation: Urologe A. 1995 Jul;34(4):334-42
references.pmid: 7545846
references.citation: J Urol. 1970 May;103(5):641-4
references.pmid: 5443849
references.citation: Clin Exp Metastasis. 1990 Nov-Dec;8(6):511-8
references.pmid: 2146053
references.citation: J Urol. 1997 Sep;158(3 Pt 1):869-71
references.pmid: 9258101
references.citation: J Urol. 1987 Jun;137(6):1189-91
references.pmid: 3586152