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Published on: February 12, 2022
Impact of Early Detection and Varying Duration of Chemoprophylaxis on Venous Thromboembolism After Robot-Assisted
Yuki Maruyama1, Takuya Sadahira1, Takanori Sekito1
1Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan.
Objective:
Venous thromboembolism (VTE) is one of the serious complications after robot-assisted radical cystectomy (RARC). This study aims to investigate the optimal duration of VTE prophylaxis and the predictive value of D-dimer measurement on the early detection of VTE.
Methods:
Retrospectively, we evaluated 86 RARC patients from July 2020 to September 2023. Thromboprophylaxis was modified two times (July 2020-; no-enoxaparin administration, June 2021-; enoxaparin for one week postoperatively, December 2022-; for two weeks), and patients were divided into three groups according to the duration. For early detection of VTE, D-dimer was measured postoperatively over time. In cases of D-dimer exceeding 10 μg/mL, contrast-enhanced CT was performed. The incidence of VTE was analyzed, and multivariate analysis was performed to identify the predictive factors.
Results:
Of the 40 patients who experienced postoperative D-dimer levels > 10 μg/mL, 37 underwent CT or ultrasound. VTE was observed in 10/26 cases (38%) in the no-enoxaparin group, 8/36 cases (22%) in the one-week group, and 1/24 cases (4%) in the two-week group, with a significant difference in incidence between the no-enoxaparin and 2-week groups (p = 0.005). Symptomatic VTE was observed in only one case in the no-enoxaparin group. Multivariate analyses of VTE predictive factors showed significant differences in D-dimer levels ≥ 12 on postoperative day 1 (OR = 14.2, 95% CI 2.47-81.1, p = 0.003) and enoxaparin administration for two weeks (OR = 0.10, 95% CI 0.01-0.96, p = 0.046).
Conclusion:
Chemoprophylaxis for 2 weeks significantly reduces the risk of VTE after RARC. In addition, routine measurement of D-dimer enables early detection of asymptomatic VTE, helping to prevent the development of symptomatic VTE.
