Il tromboembolismo venoso in chirurgia urologica: fattori di rischio e strategie di tromboprofilassi

December 2009
Urologia;2009 Supplement, Vol. 76 Issue S-12, pS22
Academic Journal
Surgery and especially cancer surgery is recognised as a risk condition for the development of venous trhomboembolism (VTE), deep venous thrombosis (DVT) and pulmonary embolism (PE). VTE is considered the most important non surgical complication of major urological procedures. Epidemiological data are based on studies published 10-30 years ago and mostly based on venographic diagnosis of DVT. Clinical revelance of asymptomatic detected DVT is under debate. The rationale for thromboprophylaxis is based on the high prevalence of VTE among hospitalized patients, the clinically silent nature of the disease in the majority of patients, and the morbidity, costs, and potential mortality associated with unprevented thrombi. Both DVT and PE produce few specific symptoms, and the clinical diagnosis is unreliable. Since the first manifestation of the disease may be fatal PE, it is inappropriate to wait for symptoms and then rely on the diagnosis and treatment of established VTE. The thromboprophylaxis strategies are still debated with regards to therapeutical choices (pharmacological and/or mechanic prophylaxis) and modalities. The strategy to be applied in patients chronically under anticoagulant or antiplatelet drugs (TAO) is also a controversial issue. METHODS: Literature review on VTE and antithrombotic prophylaxis in urological cancer surgery. RESULTS: Although the incidence of VTE is lower in urological patients than that in the others, thromboprophylaxis is still a debated topic for urologists. A protective role is the shorter duration of a lot of endourological procedure and the reduced need of general anesthesia. Nowadays patients are elderly and have multiple risk factors so they have to receive a valid and safe thromboprophylaxis. Even if the risk of bleeding is bigger in patients who received antithrombotic pro philaxys this do not allow to ignore the bigger risk/benefits ratio of the antithrombotic therapies. CONCLUSIONS: VTE is a serious complication of the urologic cancer surgery and remains the most common cause of death in these patients. New efforts must be done to reduce the risk ant to optimize the prophylapctic strategies particularly in patients with known risk factors.


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