POL Scientific / Bladder / Volume 11 / Issue 4 / DOI: 10.14440/bladder.2024.0041
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RESEARCH ARTICLE

Incidence, risk factors, and the role of anticoagulation therapy in venous thromboembolism following radical cystectomy

Randall Bissette1 ,  Maxwell Sandberg2* ,  Stephen Tranchina2 ,  Kimberly Waggener2 ,  Madeline Snipes2 ,  Emily Ye3 ,  Jabrina Simmons4 ,  John Strobel5 ,  Ashok Hemal2 ,  Alejandro Rodriguez2 ,  Ronald Davis III2
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1 Virginia Tech Carilion School of Medicine, Roanoke, Virginia, 24016 United States
2 Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, 27157 United States
3 Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27101 United States
4 Northeast Ohio Medical University, Rootstown, Ohio, 44272 United States
5 Indiana University School of Medicine, Indianapolis, Indiana, 46202 United States
Bladder 2024 , 11(4), e21200020; https://doi.org/10.14440/bladder.2024.0041
Submitted: 26 September 2024 | Revised: 18 October 2024 | Accepted: 31 October 2024 | Published: 6 December 2024
© 2024 by the Bladder published by POL Scientific. Licensee POL Scientific, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Background: Radical cystectomy (RC) for bladder cancer is associated with substantial postoperative complications. Among these complications, venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is particularly notable for its morbidity. Efforts to reduce VTE have been largely revolving around extended thromboprophylaxis (ETP) after discharge, typically with injectable heparins, and, more recently, with oral anticoagulants. Objective: The purpose of this study was to quantify the incidence of VTE within 90 days following RC and to identify risk factors associated with its development. Methods: We conducted a retrospective review of all patients who underwent RC for bladder cancer at our institution between 2012 and 2024, documenting instances of postoperative VTE. Data on demographics, anticoagulation therapy, surgical approach, and hospitalization were collected and analyzed. Results: A total of 372 patients received RC for bladder cancer during the study. Of them, 12 patients (3.2%) developed VTE at some point after surgery. The median time to VTE occurrence was between 31 and 90 days post-discharge. A higher rate of VTE was observed immediately following RC in patients who underwent surgery before 2018 (p = 0.021), the year in which enhanced recovery after surgery (ERAS) protocols were implemented. Demographic factors and operation-related variables did not influence the VTE rate (p > 0.05). Kaplan–Meier analysis revealed that cancer-specific survival was significantly lower in patients who developed VTE after RC compared to those who did not (p < 0.001). Conclusion: These findings underscored the importance of interventions such as ETP and ERAS protocols in reducing the incidence of VTE following RC for bladder cancer.

Keywords
Anticoagulation
Deep vein thrombosis
Direct oral anticoagulants
Enhanced recovery after surgery
Pulmonary embolism
Radical cystectomy
Venous thromboembolism
Funding
None.
References
  1. Tan WS, Lamb BW, Kelly JD. Complications of radical cystectomy and orthotopic reconstruction. Adv Urol. 2015;2015:323157. doi: 10.1155/2015/323157

 

  1. Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55(1):164-174. doi: 10.1016/j.eururo.2008.07.031

 

  1. Hautmann RE, de Petriconi RC, Volkmer BG. 25 years of experience with 1,000 neobladders: Long-term complications. J Urol. 2011;185(6):2207-2212. doi: 10.1016/j.juro.2011.02.006

 

  1. Sun AJ, Djaladat H, Schuckman A, Miranda G, Cai J, Daneshmand S. Venous thromboembolism following radical cystectomy: Significant predictors, comparison of different anticoagulants and timing of events. J Urol. 2015;193(2):565-569. doi: 10.1016/j.juro.2014.08.085

 

  1. Laymon M, Harraz A, Elshal A, et al. Venous thromboembolism after radical cystectomy and urinary diversion: A single-center experience with 1737 consecutive patients. Scand J Urol. 2019;53(6):392-397. doi: 10.1080/21681805.2019.1698652

 

  1. Maibom SL, Joensen UN, Poulsen AM, Kehlet H, Brasso K, Røder MA. Short-term morbidity and mortality following radical cystectomy: A systematic review. BMJ Open. 2021;11(4):e043266. doi: 10.1136/bmjopen-2020-043266

 

  1. Elsayed AS, Ozair S, Iqbal U, et al. Prevalence and predictors of venous thromboembolism after robot-assisted radical cystectomy. Urology. 2021;149:146-153. doi: 10.1016/j.urology.2020.11.014

 

  1. Tyson MD, Castle EP, Humphreys MR, Andrews PE. Venous thromboembolism after urological surgery. J Urol. 2014;192(3):793-797. doi: 10.1016/j.juro.2014.02.092

 

  1. VanDlac AA, Cowan NG, Chen Y, et al. Timing, incidence and risk factors for venous thromboembolism in patients undergoing radical cystectomy for malignancy: A case for extended duration pharmacological prophylaxis. J Urol. 2014;191(4):943-947. doi: 10.1016/j.juro.2013.10.096

 

  1. Clément C, Rossi P, Aissi K, et al. Incidence, risk profile and morphological pattern of lower extremity venous thromboembolism after urological cancer surgery. J Urol. 2011;186(6):2293-2297. doi: 10.1016/j.juro.2011.07.074

 

  1. Alberts BD, Woldu SL, Weinberg AC, Danzig MR, Korets R, Badani KK. Venous thromboembolism after major urologic oncology surgery: A focus on the incidence and timing of thromboembolic events after 27,455 operations. Urology. 2014;84(4):799-806. doi: 10.1016/j.urology.2014.05.055

 

  1. Pariser JJ, Pearce SM, Anderson BB, et al. Extended duration enoxaparin decreases the rate of venous thromboembolic events after radical cystectomy compared to inpatient only subcutaneous heparin. J Urol. 2017;197(2):302-307. doi: 10.1016/j.juro.2016.08.090

 

  1. Tikkinen KA, Craigie S, Agarwal A, et al. Procedure-specific risks of thrombosis and bleeding in urological cancer surgery: Systematic review and meta-analysis. Eur Urol. 2018;73(2):242-251. doi: 10.1016/j.eururo.2017.03.008

 

  1. Doiron RC, Booth CM, Wei X, Siemens DR. Risk factors and timing of venous thromboembolism after radical cystectomy in routine clinical practice: A population-based study. BJU Int. 2016;118(5):714-722. doi: 10.1111/bju.13443

 

  1. Sobhani S, Ghoreifi A, Douglawi A, et al. Perioperative mortality for radical cystectomy in the modern Era: Experience from a tertiary referral center. Int Braz J Urol. 2023;49(3):351-358. doi: 10.1590/s1677-5538.Ibju.2022.0405

 

  1. Gangireddy C, Rectenwald JR, Upchurch GR, et al. Risk factors and clinical impact of postoperative symptomatic venous thromboembolism. J Vasc Surg. 2007;45(2):335-341; discussion 341-2. doi: 10.1016/j.jvs.2006.10.034

 

  1. Dyer J, Wyke S, Lynch C. Hospital episode statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: A review of 126,891 cases. Ann R Coll Surg Engl. 2013;95(1):65-69. doi: 10.1308/003588413x13511609956219

 

  1. Murray KM, Parker W, Stephany H, et al. Venous thromboembolism after radical cystectomy: Experience with screening ultrasonography. Arab J Urol. 2016;14(1):37-43. doi: 10.1016/j.aju.2015.11.002

 

  1. Lyon TD, Tollefson MK, Shah PH, et al. Temporal trends in venous thromboembolism after radical cystectomy. Urol Oncol. 2018;36(8):361.e15-361.e21. doi: 10.1016/j.urolonc.2018.05.015

 

  1. Faraj KS, Judge N, Blodgett G, Tyson 2nd MD. Relationship between operative duration and perioperative outcomes after radical cystectomy. Can J Urol. 2021;28(2):10603-10609.

 

  1. Furrer MA, Abgottspon J, Huber M, et al. Perioperative continuation of aspirin, oral anticoagulants or bridging with therapeutic low-molecular-weight heparin does not increase intraoperative blood loss and blood transfusion rate in cystectomy patients: An observational cohort study. BJU Int. 2022;129(4):512-523. doi: 10.1111/bju.15599

 

  1. Gurayah AA, Blachman-Braun R, Machado CJ, et al. Clinical variables associated with major adverse cardiac events following radical cystectomy. BJUI Compass. 2024;5(4): 480-488. doi: 10.1002/bco2.315

 

  1. Yamashita R, Nakamura M, Okayama Y, et al. Incidence and location of perioperative deep vein thrombosis in patients with bladder cancer undergoing radical cystectomy. Int J Urol. 2022;29(3):259-264. doi: 10.1111/iju.14760

 

  1. Lyon TD, Shah ND, Tollefson MK, et al. Trends in extended-duration venous thromboembolism prophylaxis following radical cystectomy. Urology. 2020;136:105-111. doi: 10.1016/j.urology.2019.09.047

 

  1. Klaassen Z, Arora K, Goldberg H, et al. Extended venous thromboembolism prophylaxis after radical cystectomy: A call for adherence to current guidelines. J Urol. 2018;199(4): 906-914. doi: 10.1016/j.juro.2017.08.130

 

  1. Zaid HB, Yang DY, Tollefson MK, et al. Safety and efficacy of extended duration of thromboembolic prophylaxis following radical cystectomy: An initial institutional experience. Urol pract. 2016;3(6):462-467. doi: 10.1016/j.urpr.2016.01.002

 

  1. Schomburg J, Krishna S, Soubra A, et al. Extended outpatient chemoprophylaxis reduces venous thromboembolism after radical cystectomy. Urol Oncol. 2018;36(2):77.e9-77.e13. doi: 10.1016/j.urolonc.2017.09.029

 

  1. Kukreja JE, Levey HR, Scosyrev E, et al. Effectiveness and safety of extended-duration prophylaxis for venous thromboembolism in major urologic oncology surgery. Urol Oncol. 2015;33(9):387.e7-16. doi: 10.1016/j.urolonc.2014.12.010

 

  1. Chiang HA, Cheng PJ, Speed JM, et al. Implementation of a perioperative venous thromboembolism prophylaxis program for patients undergoing radical cystectomy on an enhanced recovery after surgery protocol. Eur Urol Focus. 2020;6(1): 74-80. doi: 10.1016/j.euf.2018.08.025

 

  1. Dall CP, Shaw N, Egan J, et al. Practice patterns for extended venous thromboembolism chemoprophylaxis among urologic oncologists after radical cystectomy. Urol Oncol. 2020;38(11):849.e19-849.e23. doi: 10.1016/j.urolonc.2020.05.030

 

  1. Ortiz RM, Golijanin B, O’Rourke TK, et al. Direct oral anticoagulants for venous thromboembolism prophylaxis following robot-assisted radical cystectomy: A retrospective feasibility study at a single academic medical center. Urology. 2021;156:154-162. doi: 10.1016/j.urology.2021.04.054

 

  1. Rosen G, Anwar T, Syed J, et al. Initial experience with apixaban for extended venous thromboembolism prophylaxis after radical cystectomy. Eur Urol Focus. 2022;8(2):480-482. doi: 10.1016/j.euf.2021.03.007

 

  1. Faraj KS, Durant A, Mauler D, et al. Extended anticoagulation after radical cystectomy using direct acting oral anticoagulants: A single-institutional experience. Urol pract. 2022;9(5): 451-458. doi: 10.1097/upj.0000000000000330

 

  1. Rich JM, Elkun Y, Geduldig J, et al. Outcomes from a prospectively implemented protocol using apixaban after robot-assisted radical cystectomy. BJU Int. 2023;132(4): 390-396. doi: 10.1111/bju.16036

 

  1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213. doi: 10.1097/01.sla.0000133083.54934.ae

 

  1. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien- Dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250(2):187-196. doi: 10.1097/SLA.0b013e3181b13ca2

 

  1. Mitropoulos D, Artibani W, Biyani CS, Bjerggaard Jensen J, Rouprêt M, Truss M. Validation of the Clavien-Dindo grading system in urology by the European Association of urology guidelines ad-hoc panel. Eur Urol Focus. 2018;4(4):608-613. doi: 10.1016/j.euf.2017.02.014

 

  1. Cano Garcia C, Tappero S, Piccinelli ML, et al. In-Hospital venous thromboembolism and pulmonary embolism after major urologic cancer surgery. Ann Surg Oncol. 2023;30(13): 8770-8779. doi: 10.1245/s10434-023-14246-0

 

  1. Russo P, Marino F, Rossi F, et al. Is Systemic immune-inflammation index a real non-invasive biomarker to predict oncological outcomes in patients eligible for radical cystectomy? Medicina (Kaunas). 2023;59(12):2063. doi: 10.3390/medicina59122063

 

  1. Siech C, Baudo A, de Angelis M, et al. Perioperative complications and in-hospital mortality in radical cystectomy patients with heart-valve replacement. Eur J Surg Oncol. 2024;50(6):108297. doi: 10.1016/j.ejso.2024.108297

 

  1. Di Bello F, Siech C, de Angelis M, et al. Perioperative complications and in-hospital mortality in paraplegic radical cystectomy patients. Ann Surg Oncol. 2024. [Published online on 2024 Oct 08]. doi: 10.1245/s10434-024-16332-3

 

  1. Pridgeon S, Allchorne P, Turner B, Peters J, Green J. Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: A UK national audit. BJU Int. 2015;115(2): 223-229. doi: 10.1111/bju.12693

 

  1. Violette PD, Vernooij RW, Aoki Y, et al. An International survey on the use of thromboprophylaxis in urological surgery. Eur Urol Focus. 2021;7(3):653-658. doi: 10.1016/j.euf.2020.05.015

 

  1. Vlad O, Catalin B, Mihai H, et al. Enhanced recovery after surgery (ERAS) protocols in patients undergoing radical cystectomy with Ileal urinary diversions: A randomized controlled trial. Medicine (Baltimore). 2020;99(27):e20902. doi: 10.1097/md.0000000000020902

 

  1. Semerjian A, Milbar N, Kates M, et al. Hospital charges and length of stay following radical cystectomy in the enhanced recovery after surgery era. Urology. 2018;111:86-91. doi: 10.1016/j.urology.2017.09.010

 

  1. Siracusano S, Gontero P, Mearini E, et al. Short-term effects of bowel function on global health quality of life after radical cystectomy. Minerva Urol Nephrol. 2024;76(4):452-457. doi: 10.23736/s2724-6051.24.05730-6

 

  1. Tania C, Sihombing AT, Siregar S. Comparison of direct oral anticoagulant (DOAC) versus low-molecular-weight heparin (LMWH) for venous thromboprophylaxis after radical cystectomy: A systematic review and meta-analysis. Urol Oncol. 2024. [Published online on 2024 Sep 28]. doi: 10.1016/j.urolonc.2024.09.023

 

  1. Rich JM, Geduldig J, Elkun Y, et al. Thromboembolic events after robotic radical cystectomy: A comparative analysis of extended and limited prophylaxis. Urology. 2024;190:46-52. doi: 10.1016/j.urology.2024.03.042
Conflict of interest
The authors declare no conflict of interest.
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Bladder, Electronic ISSN: 2327-2120 Print ISSN: TBA, Published by POL Scientific
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