Thromboprophylaxis

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K.A.O. Tikkinen (Chair), R. Cartwright, M.K. Gould, R. Naspro, G. Novara, P.M. Sandset, P.D. Violette, G.H. Guyatt

1.INTRODUCTION

1.1.Aims and objectives

Due to the hypercoagulable state induced by surgery, serious complications of urological surgery include deep vein thrombosis (DVT) and pulmonary embolism (PE) - together referred to as venous thromboembolism (VTE) - and major bleeding [1-4]. Decisions regarding pharmacologic thromboprophylaxis in urologic surgery involve a trade-off between decreased risk of (VTE) and increased risk of bleeding [1-3]. Currently, there exists substantial practice variation in the use of thromboprophylaxis in urology, both within and between countries [5-7]. This variation is unsurprising when one considers that recommendations from national and international guidelines often conflict [2].

To date, existing recommendations for thromboprophylaxis have been limited by a lack of urology-specific evidence [2]. Decisions regarding thromboprophylaxis require both estimates of relative effects on VTE and bleeding, and absolute risks of VTE and bleeding in the absence of prophylaxis (the latter is refered to as baseline risk). Substantial evidence from randomised control trials (RCTs) across a range of surgical procedures is available, and it is reasonable to assume that relative effects of prophylaxis are similar across surgical procedures. Evidence regarding baseline risk across urological procedures is, however, more limited, and systematic summaries of the available evidence have thus far been unavailable [1,3].

To develop these guidelines, the Panel conducted systematic reviews of the baseline risk of VTE and bleeding in a wide variety of urological procedures [1,8,9]. These reviews provide a stronger evidence base for urological thromboprophylaxis guidelines than has been previously available.

Utilising this newly summarised evidence [8,9], these Guidelines from the European Association of Urology (EAU) Working Panel on Thromboprophylaxis in Urological Surgery provide practical evidence-based guidance regarding post-surgery thromboprophylaxis and peri-operative management of antithrombotic agents in urology.

Clinicians who wish to implement our recommendations should bear in mind that guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to guide decisions that must also take into account patients’ values and preferences as well as their individual circumstances. Guidelines are not mandates and do not purport to be a legal standard of care.

1.2.Panel composition

The EAU Guidelines on Thromboprophylaxis in Urological Surgery Panel consists of physicians/methodologists with expertise from urology, internal medicine, haematology, gynaecology and clinical epidemiology. Although the Guidelines are written primarily for urologists, they can also be used by other physicians, patients or other interested parties.

1.3.Available publications

A quick reference document, the Pocket Guidelines, is also available, both in print and as a mobile application, presenting the main findings of the Thromboprophylaxis in Urological Surgery Guidelines. These are abridged versions which may require consultation together with the full text version. All are available through the EAU website: http://www.uroweb.org/guidelines/.

1.4.Publication history

These EAU Guidelines on Thromboprophylaxis in Urological Surgery are the first of their kind.

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