Kari A O Tikkinen1, Samantha Craigie2, Arnav Agarwal3, Philippe D Violette4, Giacomo Novara5, Rufus Cartwright6, Richard Naspro7, Reed A C Siemieniuk8, Bassel Ali9, Leyla Eryuzlu3, Johanna Geraci9, Judi Winkup9, Daniel Yoo3, Michael K Gould10, Per Morten Sandset11, Gordon H Guyatt12. 1. Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: kari.tikkinen@gmail.com. 2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote National Pain Centre, McMaster University, Hamilton, ON, Canada. 3. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; School of Medicine, University of Toronto, Toronto, ON, Canada. 4. Department of Surgery, Division of Urology, Woodstock General Hospital, Woodstock, ON, Canada; McMaster Department of Surgery Division of Urology, Hamilton, ON, Canada. 5. Department of Surgical, Oncological, and Gastroenterological Sciences, Urology Clinic, University of Padua, Padua, Italy. 6. Department of Epidemiology and Biostatistics, Imperial College London, London, UK; Department of Urogynaecology, St Mary's Hospital, London, UK. 7. Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy. 8. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada. 9. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. 10. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA. 11. Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Haematology, Oslo University Hospital, Oslo, Norway. 12. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
Abstract
CONTEXT: Pharmacological thromboprophylaxis involves balancing a lower risk of venous thromboembolism (VTE) against a higher risk of bleeding, a trade-off that critically depends on the risks of VTE and bleeding in the absence of prophylaxis (baseline risk). OBJECTIVE: To provide estimates of the baseline risk of symptomatic VTE and bleeding requiring reoperation in urological cancer surgery. EVIDENCE ACQUISITION: We identified contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. We used studies with the lowest risk of bias and accounted for use of thromboprophylaxis and length of follow-up to derive best estimates of the baseline risks within 4 wk of surgery. We used the GRADE approach to assess the quality of the evidence. EVIDENCE SYNTHESIS: We included 71 studies reporting on 14 urological cancer procedures. The quality of the evidence was generally moderate for prostatectomy and cystectomy, and low or very low for other procedures. The duration of thromboprophylaxis was highly variable. The risk of VTE in cystectomies was high (2.6-11.6% across risk groups) whereas the risk of bleeding was low (0.3%). The risk of VTE in prostatectomies varied by procedure, from 0.2-0.9% in robotic prostatectomy without pelvic lymph node dissection (PLND) to 3.9-15.7% in open prostatectomy with extended PLND. The risk of bleeding was 0.1-1.0%. The risk of VTE following renal procedures was 0.7-2.9% for low-risk patients and 2.6-11.6% for high-risk patients; the risk of bleeding was 0.1-2.0%. CONCLUSIONS: Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without PLND in low-risk patients). For "close call" procedures, decisions will depend on values and preferences with regard to VTE and bleeding. PATIENT SUMMARY: Clinicians often give blood thinners to patients to prevent blood clots after surgery for urological cancer. Unfortunately, blood thinners also increase bleeding. This study provides information on the risk of clots and bleeding that is crucial in deciding for or against giving blood thinners.
CONTEXT: Pharmacological thromboprophylaxis involves balancing a lower risk of venous thromboembolism (VTE) against a higher risk of bleeding, a trade-off that critically depends on the risks of VTE and bleeding in the absence of prophylaxis (baseline risk). OBJECTIVE: To provide estimates of the baseline risk of symptomatic VTE and bleeding requiring reoperation in urological cancer surgery. EVIDENCE ACQUISITION: We identified contemporary observational studies reporting symptomatic VTE or bleeding after urological procedures. We used studies with the lowest risk of bias and accounted for use of thromboprophylaxis and length of follow-up to derive best estimates of the baseline risks within 4 wk of surgery. We used the GRADE approach to assess the quality of the evidence. EVIDENCE SYNTHESIS: We included 71 studies reporting on 14 urological cancer procedures. The quality of the evidence was generally moderate for prostatectomy and cystectomy, and low or very low for other procedures. The duration of thromboprophylaxis was highly variable. The risk of VTE in cystectomies was high (2.6-11.6% across risk groups) whereas the risk of bleeding was low (0.3%). The risk of VTE in prostatectomies varied by procedure, from 0.2-0.9% in robotic prostatectomy without pelvic lymph node dissection (PLND) to 3.9-15.7% in open prostatectomy with extended PLND. The risk of bleeding was 0.1-1.0%. The risk of VTE following renal procedures was 0.7-2.9% for low-risk patients and 2.6-11.6% for high-risk patients; the risk of bleeding was 0.1-2.0%. CONCLUSIONS: Extended thromboprophylaxis is warranted in some procedures (eg, open and robotic cystectomy) but not others (eg, robotic prostatectomy without PLND in low-risk patients). For "close call" procedures, decisions will depend on values and preferences with regard to VTE and bleeding. PATIENT SUMMARY: Clinicians often give blood thinners to patients to prevent blood clots after surgery for urological cancer. Unfortunately, blood thinners also increase bleeding. This study provides information on the risk of clots and bleeding that is crucial in deciding for or against giving blood thinners.
Authors: David R Anderson; Gian Paolo Morgano; Carole Bennett; Francesco Dentali; Charles W Francis; David A Garcia; Susan R Kahn; Maryam Rahman; Anita Rajasekhar; Frederick B Rogers; Maureen A Smythe; Kari A O Tikkinen; Adolph J Yates; Tejan Baldeh; Sara Balduzzi; Jan L Brożek; Itziar Etxeandia- Ikobaltzeta; Herman Johal; Ignacio Neumann; Wojtek Wiercioch; Juan José Yepes-Nuñez; Holger J Schünemann; Philipp Dahm Journal: Blood Adv Date: 2019-12-10
Authors: Tamar A J van den Berg; Robert C Minnee; Ton Lisman; Gertrude J Nieuwenhuijs-Moeke; Jacqueline van de Wetering; Stephan J L Bakker; Robert A Pol Journal: Transpl Int Date: 2019-01-02 Impact factor: 3.782
Authors: Frederik König; Nico C Grossmann; Francesco Soria; David D'Andrea; Tristan Juvet; Aaron Potretzke; Hooman Djaladat; Alireza Ghoreifi; Eiji Kikuchi; Nozomi Hayakawa; Andrea Mari; Zine-Eddine Khene; Kazutoshi Fujita; Jay D Raman; Alberto Breda; Matteo Fontana; John P Sfakianos; John L Pfail; Ekaterina Laukhtina; Pawel Rajwa; Maximilian Pallauf; Giovanni E Cacciamani; Thomas van Doeveren; Joost L Boormans; Alessandro Antonelli; Marcus Jamil; Firas Abdollah; Jeffrey Budzyn; Guillaume Ploussard; Axel Heidenreich; Siamak Daneshmand; Stephen A Boorjian; Morgan Rouprêt; Michael Rink; Shahrokh F Shariat; Benjamin Pradere Journal: Cancers (Basel) Date: 2022-03-31 Impact factor: 6.639