Heparin prophylaxis and the risk of venous thromboembolism after robotic‐assisted laparoscopic prostatectomy

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The incidence of deep venous thrombosis (DVT) in major urological surgery has decreased over time with the introduction of pharmacological prophylaxis, early mobilization, and the use of sequential mechanical compression devices. We examined the value of heparin prophylaxis in robotic assisted laparoscopic prostatectomy (RALP), where the risk of DVT is already low. The rate of thromboemolic events within 30 days was 0.6% in this series. Heparin did not influence estimated blood loss, haematrocrit change, or length of stay. The incidence of thromboembolism is low after RALP, which may obviate the use of heparin prophylaxis. However, its use appears to be safe and does not affect surgical outcomes. 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. MATERIALS AND 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). CONCLUSION • 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.