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Inicio Medicina Clínica (English Edition) Pharmacological venous thromboembolism prophylaxis in radical prostatectomy
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Vol. 154. Issue 4.
Pages 113-118 (February 2020)
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Vol. 154. Issue 4.
Pages 113-118 (February 2020)
Original article
DOI: 10.1016/j.medcle.2019.04.035
Pharmacological venous thromboembolism prophylaxis in radical prostatectomy
Profilaxis farmacológica de la tromboembolia venosa en la prostatectomía radical
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Sebastian Valverde-Martineza,b, Laura-Andrea Gonzalez-Rayoc, Barbara Padilla-Fernandezd, Jorge Pereira-Brunoe, Hugo Coelhof, Manuel Montesino-Semperg, Carlos Müller-Arteagah, Jose-Luis Alvarez-Ossorio-Fernandezi, Filippo Migliorinij, Maria-Begoña Garcia-Cenadork, Maria-Fernanda Lorenzo-Gomeza,k,l,
Corresponding author
mflorenzogo@yahoo.es

Corresponding author.
a Grupo de Investigación Multidisciplinar Urológico de Renal (GRUMUR), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
b Servicio de Urología, Complejo Asistencial Universitario de Ávila, Ávila, Spain
c Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
d Servicio de Urología. Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
e Servicio de Urología, Hospital Universitario Pêro da Covilhã, Covilhã, Portugal
f Servicio de Urología, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
g Servicio de Urología, Hospital Universitario Virgen del Camino, Pamplona, Spain
h Servicio de Urología, Complejo Universitario Hospitalario de Ourense, Ourense, Spain
i Servicio de Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain
j Servicio de Urología, Hospital Azienda Ospedaliera Universitaria Integrata,Verona, Italy
k Departamento de Cirugía, Universidad de Salamanca, Salamanca, Spain
l Servicio de Urología, Hospital Universitario de Salamanca, Salamanca, Spain
Related content
Med Clin. 2020;155:18910.1016/j.medcle.2020.07.001
Sebastian Valverde-Martinez, Laura-Andrea Gonzalez-Rayo, Barbara Padilla-Fernandez, Jorge Pereira-Bruno, Hugo Coelho, Manuel Montesino-Semper, Carlos Müller-Arteaga, Jose-Luis Alvarez-Ossorio-Fernandez, Filippo Migliorini, Maria-Begoña Garcia-Cenador, Maria-Fernanda Lorenzo-Gomez
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Tables (7)
Table 1. Venous thromboembolic risk model according to patient risk factors.
Table 2. Descriptive statistics of the patient groups who received and those who did not receive venous thromboembolic drug prophylaxis.
Table 3. Use of venous thromboembolic prophylaxis in men who underwent different radical prostatectomy techniques. Pharmacological prophylaxis and its relationship with thromboembolic events in the different techniques.
Table 4. Use of venous thromboembolic drug prophylaxis in men who underwent radical prostatectomy according to thromboembolic risk groups.
Table 5. Venous thromboembolic events in men who underwent radical prostatectomy according to the thromboembolic risk groups and the use of thromboembolic pharmacological prophylaxis.
Table 6. Use of venous thromboembolic prophylaxis in men who underwent radical prostatectomy according to hemorrhagic risk groups.
Table 7. Hemorrhagic events in men who underwent radical prostatectomy according to the hemorrhagic risk groups and the use of thromboembolic pharmacological prophylaxis.
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Abstract
Background and aim

Pulmonary thromboembolism is one of the most common causes of non-surgical death in patients following urological abdominopelvic surgery. Since the beginning of prophylaxis for venous thromboembolic disease, episodes of deep vein thrombosis and pulmonary thromboembolism have decreased. Our objective is to analyse the prognosis factors of thromboembolic disease, the clinical variability in the use of pharmacological prophylaxis and the results of its application.

Material and methods

Retrospective multicentric study of 610 patients undergoing radical prostatectomy between December 2013 and November 2014, in 7 general hospitals in Spain, Italy and Portugal. Patients were classified according to their baseline characteristics into thrombotic risk groups and haemorrhagic risk groups. The venous thromboembolic events that occurred in the different groups were analysed.

Results

The average age was 65.22 years (48–78). The average body mass index was 26.7 and the average ASA risk 2.1. In all patients, early mobilization began in the first 24h. In 4.1% intermittent pneumatic compression was used and 84.6% received pharmacological prophylaxis with low molecular weight heparins. Only 3.4% used the combination of mechanical prophylaxis with pharmacological prophylaxis. We observed a decrease in the incidence of thromboembolic events in the patients who received pharmacological prophylaxis, with an absolute risk reduction of 6.8%. There was no increase in the risk of haemorrhage in the patients who received pharmacological prophylaxis.

Conclusions

In this study on patients undergoing radical prostatectomy, there was no difference in haemorrhagic complications derived from the use of pharmacological prophylaxis for venous thromboembolic disease. Pharmacological prophylaxis reduces the risk of presenting a thromboembolic event in patients undergoing radical prostatectomy, although this risk is not associated with the approach technique.

Palabrasclave:
Prostatectomía radical
Profilaxis tromboembólica
Variabilidad clínica
Keywords:
Radical prostatectomy
Thromboembolic prophylaxis
Clinical variability
Resumen
Antecedentes y objetivo

La tromboembolia pulmonar es una de las causas más comunes de muerte no quirúrgica en pacientes sometidos a cirugía urológica abdomino-pélvica. Desde el inicio de la profilaxis para la enfermedad tromboembólica venosa los episodios de trombosis venosa profunda y tromboembolia pulmonar han descendido considerablemente. Nuestro objetivo es analizar los predictores de la enfermedad tromboembólica, la variabilidad clínica en la utilización de la profilaxis farmacológica para esta enfermedad y los resultados de su aplicación.

Material y métodos

Estudio retrospectivo multicéntrico de 610 pacientes intervenidos mediante prostatectomía radical entre diciembre 2013 y noviembre de 2014, en 7 hospitales generales de España, Italia y Portugal. Se clasificaron a los pacientes según sus características basales en grupos de riesgo trombótico y grupos de riesgo hemorrágico. Se evaluaron los eventos tromboembólicos venosos que se presentaron en los diferentes grupos.

Resultados

La edad media fue de 65,22 años (48–78). El índice de masa corporal medio de 26,7 y la mediana del riesgo de ASA fue 2. En todos los pacientes se inició la deambulación en las primeras 24 horas. En 4.1% se utilizó compresión neumática intermitente y en un 84.6% profilaxis farmacológica con heparinas de bajo peso molecular. Solo en un 3.4% se utilizo la combinación de profilaxis mecánica con la farmacológica. Se observó disminución de la incidencia de eventos tromboembólicos en los pacientes que recibieron profilaxis farmacológica, con una reducción absoluta del riesgo de 6.8%. No se objetivó aumento del riesgo hemorrágico en los pacientes que recibieron profilaxis tromboembólica.

Conclusiones

En este estudio sobre pacientes sometidos a prostatectomía radical, no hubo diferencia en las complicaciones hemorrágicas derivadas del uso de profilaxis farmacológica para la enfermedad tromboembólica venosa. La profilaxis farmacológica reduce el riesgo de presentar un evento tromboembólico en pacientes sometidos a prostatectomía radical, si bien, este riesgo no se asocia con la técnica de abordaje.

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