Risks and benefits of pharmacological prophylaxis for venous thromboembolism prevention in patients undergoing robotic partial nephrectomy

Purpose We investigate the safety and efficacy of pharmacological venous thromboembolism prophylaxis in patients treated with robotic partial nephrectomy at our center. Materials and Methods We retrospectively examined our robotic partial nephrectomy database for cases performed between 2006 and 2014. Clinical venous thromboembolism episodes within 6 months from surgery were documented. Patients were stratified according to the administration of pharmacological venous thromboembolism prophylaxis into pharmacological prophylaxis (222) and no pharmacological prophylaxis (762) groups. The groups were compared in terms of perioperative outcomes, complications and adverse hemorrhagic events defined as the administration of 2 or more units of red blood cells, the need for vascular embolization or any procedures related to blood loss. Results There were no differences between the pharmacological prophylaxis and no pharmacological prophylaxis groups regarding mean operation time, median warm ischemia time and estimated blood loss. The rates of venous thromboembolism events were comparable between the groups (pharmacological prophylaxis 1.8% vs no pharmacological prophylaxis 2.1%, p=0.75). Overall 90% of venous thromboembolism events occurred within the first postoperative month. In the multivariable regression analysis encompassing pharmacological prophylaxis, perioperative aspirin intake, body mass index, operation time, Charlson comorbidity index, fellowship training and tumor complexity, operation time (OR 1.06, p=0.009) and Charlson comorbidity index (OR 1.28, p <0.0001) were associated with adverse hemorrhagic events. Conclusions The administration of pharmacological prophylaxis did not increase the rate of adverse hemorrhagic events. Isolated inpatient administration of pharmacological prophylaxis after robotic partial nephrectomy does not appear to protect against venous thromboembolism postoperatively in that the majority of venous thromboembolism events occurred within the first 30 days after surgery. Longer duration of pharmacological prophylaxis for the prevention of venous thromboembolism after robotic partial nephrectomy should be considered.