title: Heparin prophylaxis and the risk of venous thromboembolism after robotic-assisted laparoscopic prostatectomy.
abstract: OBJECTIVE
  • The incidence of venous thromboembolism (VTE) after robotic-assisted laparoscopic prostatectomy (RALP) in patients receiving perioperative heparin prophylaxis was compared with those who did not receive such prophylaxis.
  
  
  METHODS
  • Between July 2007 to February 2010, a total of 307 RALPs were performed at our institution by two surgeons. A total of 187 patients operated on by surgeon 1 received perioperative heparin prophylaxis, whereas 120 patients operated on by surgeon 2 did not receive any. • All demographic, clinical and pathological data were prospectively recorded, whereas the incidence of venous thromboembolism within 30 days of the operation was retrospectively reviewed. Evaluation for potential VTE was based on clinical symptoms.
  
  
  RESULTS
  • Cohorts were comparable with respect to PSA, clinical stage, preoperative Gleason score, body mass index, smoking status, pathological stage, path Gleason score and margin status. A total of two thromboemoblic events occurred (0.6%) within 30 days of surgery (one in each arm of the study). • Heparin prophylaxis did not influence estimated blood loss (P= 0.076) or haematocrit change from preoperative levels (P= 0.378). Length of stay was comparable between the two groups (1.4 vs 1.3 days; P= 0.159).
  
  
  CONCLUSIONS
  • The incidence of thromboembolism is low after RALP, which may obviate the need for heparin prophylaxis. However, its use is safe and does not impact surgical outcomes. Larger series are needed to confirm the results obtained in the present study.
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. tp2200@columbia.edu
authors.forename: Trushar
authors.initials: T
authors.lastname: Patel
authors.forename: Will
authors.initials: W
authors.lastname: Kirby
authors.forename: Greg
authors.initials: G
authors.lastname: Hruby
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Benson
authors.forename: James M
authors.initials: JM
authors.lastname: McKiernan
authors.forename: Ketan
authors.initials: K
authors.lastname: Badani
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000191:economics; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006493:Heparin