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Low Molecular Weight Heparin for Venous Thromboembolism Prophylaxis in Urologic Oncologic Surgery

Objectives: This is a prospective study in the use of low molecular weight heparin (LMWH) for venous thromboembolism prophylaxis in the previously unstudied subset of patients undergoing elective urologic cancer surgery. Methods: Thirty-eight patients undergoing elective urologic surgery were studied. Thirty-six had urologic malignancies. Pre-operative risk factors for venous thromboembolic disease were recorded. All patients received LMWH (dalteparin, Fragmin; Pharmacia, Stockholm, Sweden) subcutaneously on a daily basis beginning 1–2 hr before surgery and lasting for 3–7 days. Postoperative physical examination was used to check for clinical evidence of deep venous thrombosis (DVT). Clinical parameters such as physical examination and radiological testing were used to assess for evidence of DVT. Other data included intraoperative blood loss, transfusion requirements, postoperative bleeding complications, postoperative hematocrit and coagulation profiles, and local complications related to the subcutaneous injection of the LMWH. Results: All patients completed the prophylaxis protocol. None developed DVT. Mean intraoperative blood loss was 735 mL and 12 patients received an average of 1 unit of blood transfusion. No unusual hemorrhagic events were noted intra- or post-operatively. No reactions to the LMWH were noted. Average hematocrit of postoperative day 3 was 30.7 and platelet count and coagulation profiles remained normal postoperatively. Conclusions: Low molecular weight heparins appear promising for DVT prophylaxis in high-risk urology patients.