Prevention of Venous Thromboembolism

Recommendations: Urologic Surgery

In patients undergoing transurethral or other low-risk urologic procedures, we recommend against the use of specific prophylaxis other than early and persistent mobilization (Grade 1C + ).

For patients undergoing major, open urologic procedures, we recommend routine prophylaxis with LDUH twice daily or three times daily (Grade 1A). Acceptable alternatives include prophylaxis with IPC and/or GCS (Grade 1B) or LMWH (Grade 1C + ).

For urologic surgery patients who are actively bleeding, or are at very high risk for bleeding, we recommend the use of mechanical prophylaxis with GCS and/or IPC at least until the bleeding risk decreases (Grade 1C+).

For patients with multiple risk factors, we recommend combining GCS and/or IPC with LDUH or LMWH (Grade 1C+).

Laparoscopic surgery

The expanding use of laparoscopic techniques over the past 2 decades has profoundly changed surgical diagnosis and therapy. There is, however, considerable controversy related to thromboembolic complications after these pro-cedures. Laparoscopic cholecystectomy is associated with a modest thrombogenic activation of the coagulation system, as well as stimulation of fibrinolysis. In some studies, the magnitude of these changes was similar to that of changes seen after open cholecystectomy, while other studies found smaller changes among the patients undergoing laparoscopic cholecystectomy.  Canadian Health Blog here.

Laparoscopic operations are often associated with longer surgical times than are open procedures. Both pneumoperitoneum and the reverse Trendelenburg position reduce venous return from the legs, creating lower extremity venous stasis. While laparoscopic procedures are generally associated with a shorter hospital stay, patients undergoing them may not mobilize more rapidly at home than those undergoing open procedures.

Although the risks of VTE and its prevention have been less intensively studied in laparoscopic procedures compared with other abdominal procedures, the risks appear to be low. For example, among 417 UK surgeons, 91% reported having never encountered a thromboembolic complication following laparoscopic cholecystectomy, although the majority reported using LDUH routinely in these patients. About impotence.

A Danish survey found that 80% of surgical departments were not aware of any thromboembolic complications following laparoscopic surgery, although, again, prophylaxis was commonly used. In another study, no DVT or PE was encountered in the first month after laparoscopic cholecystectomy among 587 cases, of whom only 3% received thromboprophylaxis.

Among 25 patients undergoing laparoscopic cholecystectomy without any thromboprophylaxis, screening contrast venography on postoperative days 6 to 10, failed to detect any DVT.

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