Influence of low-molecular-weight heparin dosage on red blood cell transfusion, lymphocele rate and drainage duration after open radical prostatectomy.
BACKGROUND
To assess the rates of red blood cell (RBC) transfusions, pelvic lymphoceles, and prolonged drainage duration in patients after radical prostatectomy (RP) receiving perioperative bridging with low-molecular-weight heparin (LMWH).


METHODS
Between 2006 and 2009, 114 RP patients receiving bridging therapy with 60 mg (n = 63) or ≥80 mg (n = 51) Enoxaparin/d were compared to 1327 consecutive RP patients receiving 40 mg Enoxaparin/d. Logistic regression models were used to test the effect of LMWH dosage on all three outcomes. Covariables included age, body mass index (BMI), Charlson comorbidity index (CCI), prostate volume, pelvic lymph node dissection, and pathological stage.


RESULTS
The RBC transfusion rates in patients treated with 40, 60 and ≥80 mg were 4.9, 9.5 and 19.6%, respectively (p < 0.001). The respective lymphocele rates were 6.4, 3.2 and 2.0% (p = 0.26). The respective rates of drainage duration of ≥4 days were 6.7, 4.8 and 16.7% (p = 0.088). After adjusting for confounding factors, patients receiving ≥80 mg were 4.1-fold more likely to be transfused than patients receiving prophylactic LMWH (p = 0.02). Similarly, patients receiving ≥80 mg were 3.2-fold more likely to have a drainage duration of ≥4 days than patients receiving prophylactic LMWH (p = 0.03).


CONCLUSIONS
Patients with a perioperative bridging with LMWH in RP are more likely to receive a RBC transfusion and to have prolonged drainage duration. Conversely, bridging therapy was not associated with an increased risk of lymphocele formation.
Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany. janschmitges@gmx.de
J
J
Schmitges
Q-D
QD
Trinh
L
L
Jonas
L
L
Budäus
R
R
Larbig
T
T
Schlomm
P I
PI
Karakiewicz
H
H
Heinzer
H
H
Huland
M
M
Graefen
T
T
Steuber
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical; D004322:Drainage; D017984:Enoxaparin / Q000008:administration & dosage* / Q000009:adverse effects; D017707:Erythrocyte Transfusion; D006801:Humans; D008197:Lymph Node Excision; D008210:Lymphocele / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011182:Postoperative Care; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000601:surgery*
D000925:Anticoagulants; D017984:Enoxaparin