Incidence and Disease Pattern of Venous Thrombembolism after Radical Prostatectomy.

Background: Little is known about the time of development and distribution pattern of venous thrombembolism (VTE) after radical prostatectomy (RPE) for malignancy.

Patients and Methods: 415 consecutive patients undergoing standard RPE were prospectively assessed regarding the incidence and distribution pattern of VTE, the hemodynamic relevance of pelvic lymphoceles (LC) and other possible risk factors for VTE. All patients underwent RPE and received heparin prophylaxis until discharge, followed by acetylsalicylic acid 100 mg daily. On day -1, 8 and 21 complete compression ultrasound, measurement of pelvic vein flow and pelvic ultrasound were performed.

Results: VTE was found in 17,3% of patients. Most thrombi were limited to calf muscle veins (55,5%). Isolated calf deep vein thrombosis (DVT) was found in 22,2% and proximal DVT in 12,5%. On day 8 and 21 the following incidences of VTE were found: calf muscle vein thrombosis 4.8 and 4.8%; isolated calf vein thrombosis 1.7% and 2.2%; proximal DVT 0.5% and 1.7%; pulmonary embolism 0.5% and 0.5%, respectively. Multivariate analysis revealed surgery time (OR 1.26), number of blood tranfusion (OR 1.73) and venous flow reduction (OR 2.83) as risk factors for the development of VTE. 33.3% of the patients developed a LC postoperatively; of these 5.3% showed a reduction of pelvic vein flow. A venous flow reduction was only seen with LC.

Conclusion: The incidence and distribution pattern of VTE after RPE is comparable to major abdominal surgery for malignancy. The development of LC is a significant risk factor for VTE, when pelvic vein flow is impaired. Since the majority of proximal VTE developed between day 8 and day 21 when the patient is already discharged, the concept of a prolonged heparin prophylaxis after RPE should be evaluated prospectively.