AUA 2017: Thromboembolic events during treatment for renal cell carcinoma: must we prevent?
Boston, MA (UroToday.com) In this retrospective analysis over a fourteen year period, the authors describe the incidences of symptomatic venous thromboembolism (VTE) events following surgery for renal cell carcinoma. This is a relevant topic as CMS has emphasized the importance of VTE prophylaxis in the perioperative setting and in total, approximately $10 billion are spent on prevention and treatment of VTE per year. In this study consisting of over 900 radical and partial nephrectomies, the overall symptomatic VTE rate was found to be 1.1%, in line with previous reports describing the rate to be from 1-1.5%. In the 10 patients with symptomatic VTE, 60% were male, 20% underwent cytoreductive nephrectomy, and interestingly, the median time from surgery to VTE was 30 days. Older patients, and those with history of VTE’s were found to be more likely to develop VTE’s following renal surgery.
In the presentation, the authors present both sides of the dilemma with using VTE prophylaxis. On one hand, patients are exposed to VTE if insufficiently prophylaxed. On the other, they face bleeding disorders with the use of prophylaxis, especially after undergoing partial nephrectomy. Ultimately, in order to minimize risk of both VTE and unwanted bleeding, a risk stratified strategy has to be employed in the decision to use VTE prophylaxis. Despite the risk factors already described for surgeries in general, more specific risk factors for patients undergoing renal surgery are awaited.
Presented by: Jamie Olen, DO
Written By: Roger Li MD Urologic Oncology Fellow, UT MD Anderson Cancer Center @UrogerliMD
Ashish M. Kamat MD Wayne B. Duddlesten Professor, UT MD Anderson Cancer Center
at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA