EAU 2011 - Influence of high dose low molecular weight heparin (LMWH) on blood transfusion and lymphocele rate in open radical prostatectomy - Session Highlights

VIENNA, AUSTRIA (UroToday.com) - Patients requiring anticoagulation or antiplatlet therapy undergo bridging with a high dosage of LMWH during open radical prostatectomy (ORP).

This may predispose to bleeding complications requiring blood transfusion (BT) and to pelvic lymphoceles (PL). These investigators examined these rates in patients receiving high-dose LMWH for cardiovascular reasons by using a propensity score matched analysis.

Between 2005 and 2008, 112 ORP patients receiving high-dose LMWH (≥80mg Enoxaparin/day) were matched with 336 ORP patients receiving prophylactic LMWH (40mg Enoxaparin/day). All ORPs were performed by two high-volume surgeons. The 30-day BT and PL rates were assessed. Univariable and multivariable logistic regression analyses assessed BT and PL. Tested predictors comprised of LMWH dosage, age, body mass index, lymph node dissection (LND) status, prostate specific antigen (PSA), and pathological stage. Mean estimated blood loss was 632cc and 664cc in patients receiving high-dose and prophylactic LMWH, respectively (P=0.6). The transfusion rates in patients receiving high-dose LMWH vs. those receiving regular dosage were 13.4 vs. 6.3%, respectively (P=0.02). The rates of PL in patients receiving high-dose LWMH vs. those receiving regular dosage were 5.4 and 8.6%, respectively (P=0.3). In patients undergoing LND vs. those without LND, PL occurred in 13.0 and 1.5%, respectively (P<0.001). After adjusting for all covariates, patients receiving high-dose LMWH were 2.3-fold more likely to be transfused than patients with regular LMWH regimen (P=0.02). In multivariable analysis for prediction of PL, only LND achieved independent predictor status (odds ratio [OR]: 8.1, P=0.001). High-dose LMWH and all other covariates were unrelated to PL formation.


Presented by Jan Schmitges, MD, et al. at the 26th Annual European Association of Urology (EAU) Congress - March 18 - 21, 2011 - Austria Centre Vienna, Vienna, Austria


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