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Abstract
Purpose
To examine the variation in venous thromboembolism prophylactic treatment (VTEP) among renal cancer patients undergoing surgery.
Materials and methods
An Internet-based questionnaire on renal tumor management before and after surgery was mailed to all Nordic departments of urology. The questions focused on the use of VTEP and were subdivided into different surgical modalities.
Results
Questionnaires were mailed to 91 institutions (response rate 53%). None of the centers used VTEP before surgery, unless the patient had a vena caval tumor thrombus. Overall, the VTEP utilized during hospitalization for patients undergoing renal surgery included early mobilization (45%), compression stockings (52%) and low-molecular-weight heparin (89%). In patients undergoing open radical Nx, 80% of institutions used VTEP during their hospitalization (23% compression stockings and 94% low-molecular-weight heparin). After leaving the hospital, the proportion and type of VTEP received varied considerably across institutions. The most common interval, used in 60% of the institutions, was for a period of 4 weeks. The restriction to the Nordic countries was a limitation and, therefore, may not reflect the practice patterns elsewhere. It is a survey study and, therefore, cannot measure the behaviors of those institutions that did not participate.
Conclusion
We found variation in the type and duration of VTEP use for each type of local intervention for renal cancer. These widely disparate variations in care strongly argue for the establishment of national and international guidelines regarding VTEP in renal surgery.
Supplementary material
Venous-thrombotic-embolic (VTE) prophylaxis survey for renal surgery
Country in which you practice
What form(s) of VTE prophylaxis do you use in patients with renal tumors before surgery (check all that apply)?
None
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
What form(s) of VTE prophylaxis do you use in patients undergoing renal surgery while they are in the hospital (check all that apply)?
None
Early ambulation
Sequential compression device
Compression stockings
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
Do you use VTE prophylaxis in patients undergoing open nephrectomy after they leave the hospital?
Yes
No – if no go to question 7
If yes, what prophylaxis do you use (check all that apply)?
Compression stockings
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
How long do you use VTE prophylaxis after patients leave the hospital for nephrectomy?
One week
Two weeks
Four weeks
Six weeks
Other
Do you use VTE prophylaxis in patients undergoing open partial nephrectomy after they leave the hospital?
Yes
No – if no go to question 10
If yes, what prophylaxis do you use (check all that apply)?
Compression stockings
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
How long do you use VTE prophylaxis after patients leave the hospital for open partial nephrectomy?
One week
Two weeks
Four weeks
Six weeks
Other
Do you use VTE prophylaxis in patients undergoing laparoscopic/robot ass. nephrectomy after they leave the hospital?
Yes
No – if no go to question 13
If yes, what prophylaxis do you use (check all that apply)?
Compression stockings
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
How long do you use VTE prophylaxis after patients leave the hospital for laparoscopic/robot ass. Nephrectomy?
One week
Two weeks
Four weeks
Six weeks
Other
Do you use VTE prophylaxis in patients undergoing laparoscopic/robot ass. partial nephrectomy after they leave the hospital?
Yes
No – if no go to question 16
If yes, what prophylaxis do you use (check all that apply)?
Compression stockings
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
How long do you use VTE prophylaxis after patients leave the hospital for laparoscopic/robot ass. partial nephrectomy ?
One week
Two weeks
Four weeks
Six weeks
Other
Do you use VTE prophylaxis in patients undergoing laparoscopic/robotic thermal ablation of kidney tumors after they leave the hospital?
Yes
No – if no go to question 19
If yes, what prophylaxis do you use (check all that apply)?
Compression stockings
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
How long do you use VTE prophylaxis after patients leave the hospital for laparoscopic/robotic thermal ablation of kidney tumors?
One week
Two weeks
Four weeks
Six weeks
Other
Do you use VTE prophylaxis in patients undergoing percutaneous thermal ablation of kidney tumors after they leave the hospital?
Yes
No – if no finished
If yes, what prophylaxis do you use (check all that apply)?
Compression stockings
Aspirin
Direct-acting oral anticoagulants (dabigatran, apixaban, rivaroxaban, edoxaban)
Subcutaneous heparin
Low molecular weight heparin
Unfractionated heparin
Other
How long do you use VTE prophylaxis after patients leave the hospital for percutaneous thermal ablation of kidney tumors?
One week
Two weeks
Four weeks
Six weeks
Other
Acknowledgments
The Nordic Renal Cancer collaboration group is funded by the Scandinavian Association of Urology. The abstract is available online here: http://www.diva-portal.org/smash/record.jsf?pid=diva2%3A1135113&dswid=-5326.
Disclosure
The authors report no conflicts of interest in this work.