Urologie pro praxi 1/2023

Prophylaxis of thromboembolic complications in urology

Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is associated with substantial morbidity and mortality. Surgery significantly increases the risk of VTE. In thromboprophylaxis, two methods may be used – pharmacologic prophylaxis (usually low-molecular-weight heparin, LMWH) and mechanical methods (compression stockings and intermittent pneumatic compression). Mechanical methods represent an alternative for the patients with high bleeding risk or may be used in combination with LMWH to intensify the prophylaxis in those with high thromboembolic risk. Urologic surgeries may differ in thrombotic risk and some of them may be associated with high bleeding risk as well. Guidelines specify the methods of thromboprophylaxis in respective urologic procedures. If pharmacologic prophylaxis with LMWH is indicated, it should be initiated 24 hours after the surgery and the optimal duration is four weeks. In special cases, inferior vena cava filter may be considered (in a patient with a recent VTE and the need of an urgent surgery, i.e. the need of interrupting full anticoagulation). Optimal thromboprophylaxis should be based on interdisciplinary team work.

Keywords: deep vein thrombosis, pulmonary embolism, anticoagulation, risk factors, thromboprophylaxis.