title: Effectiveness and safety of extended-duration prophylaxis for venous thromboembolism in major urologic oncology surgery.
abstract: OBJECTIVE
  To examine the association between extended-duration prophylaxis (EDP), low-molecular-weight heparin prophylaxis for 28 days after surgery for urologic cancer in patients at high risk of developing a venous thromboembolism (VTE), the risk of VTE, and the complications resulting from VTE prophylaxis.
  
  
  METHODS
  The cohort included 332 patients at high risk for VTE who were surgically treated for urologic cancer from June 2011 to June 2014. Adherence to VTE prophylaxis protocol, VTEs, and complications within 365 days from surgery were tracked. Patients were grouped as follows: (1) per protocol in-hospital prophylaxis with EDP (n = 107), (2) per protocol in-hospital prophylaxis without EDP (n = 42), (3) not per protocol in-hospital prophylaxis with EDP (n = 83), and (4) not per protocol in-hospital prophylaxis without EDP (n = 100). The risk of VTE was compared between the 4 groups using the Cox model, with adjustment for baseline risk factors.
  
  
  RESULTS
  The rates of VTEs and median times to VTE were 7% and 58 days in group 1, 17% and 44 days in group 2, 17% and 46 days in group 3, and 21% and 15 days in group 4, respectively. Adjusted hazard ratios (HR) for VTE were HR = 0.27 (95% CI: 0.11-0.70) for groups 1 vs. 4; HR = 0.66 (95% CI: 0.25-1.60) for groups 2 vs. 4; and HR = 0.66 (95% CI: 0.29-1.26) for groups 3 vs. 4 with a trend of P = 0.002. The incidence of complications from VTE prophylaxis was not significantly different between the groups, with a rate of 8% in group 1, 17% in group 2, 6% in group 3, and 12% in group 4 (P = 0.33).
  
  
  CONCLUSIONS
  In high-risk urologic cancer surgery patients, a clinical protocol, with perioperative and EDP, is safe and effective in reducing VTE events.
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY. Electronic address: Janet_Kukreja@URMC.rochester.edu.
authors: Janet E Baack
authors: JE
authors: Kukreja
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Helen R
authors: HR
authors: Levey
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Emil
authors: E
authors: Scosyrev
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Maureen
authors: M
authors: Kiernan
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Claudia
authors: C
authors: Berrondo
authors: School of Medicine and Dentistry, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Carrie
authors: C
authors: McNamee
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Guan
authors: G
authors: Wu
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Jean V
authors: JV
authors: Joseph
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Ahmed
authors: A
authors: Ghazi
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Hani
authors: H
authors: Rashid
authors: Department of Public Health Sciences, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Ann
authors: A
authors: Dozier
authors: Department of Urology, Strong Memorial Hospital University of Rochester Medical Center, Rochester, NY.
authors: Edward M
authors: EM
authors: Messing
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D014571:Urologic Neoplasms / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
keywords: Neoplasms; Prevention and control; Pulmonary embolism; Surgery; Venous thrombosis