Click here to read more Quest articles. print | Print this page

Blood clots are a cause for concern after invasive surgery and patients are often prescribed low doses of heparin to prevent them; yet, there is no consensus for such a recommendation with a radical prostatectomy (RP).

Our study* looked at the records of 1,471 patients (Catalona) to see if after their operations which, if any, patients had a deep vein blood clot or a blood clot after their operation when preventative measures were used, which did not generally include low doses of heparin, a blood thinner.

For 98% of patients without a prior history to indicate potential increased risk (i.e., a personal or family history of a deep vein blood clot), preventive measures consisted of pressure socks and frequent walking. Walking started the day of the surgery and every 1 to 1 1/2 hours thereafter while the patient was awake and the same schedule for three weeks after leaving the hospital.

According to our series of patients, pressure socks and early walking were successful measures to prevent blood clots in the vast majority of patients undergoing RP.

Those others who were considered at higher risk for blood clots were additionally provided with compression devices and low dose injected heparin.

In patients with a history of possible blood clot, only one clotting event occurred when they were treated with the additional preventive measures of compression devices and heparin.

Unlike other major surgical procedures for the treatment of cancer, RP patients are able to walk on the day of surgery and usually have brief hospitalizations.Because of these factors, the rate of blood clots following radical prostatectomy is exceedingly low. Our study showed that blood clots after RRP are rare occurring in 0.8% or 12 of the 1,471 patients.

While it is important to determine proper management in the immediate postoperative period because patients with blood clots can develop significant bleeding complications and require higher transfusion rates while on anticoagulation drugs, it does appear most RP patients do well with frequent walking and pressure socks.

Our study confirms and suggests that a less aggressive preventive strategy should be considered and may be more appropriate for RRP patients than for patients undergoing other major cancer operations.

* Mechanical Prophylaxis and Early Ambulation to Prevent Thromboembolic Complications After Radical Retropubic Prostatectomy Jessica T. Casey, MD; Sarah L. Coleman, MD; Ronald J. Kim, MD; Matthias D. Hofer, MD, PhD; Stacy Loeb, MD; William J. Catalona, MD Supported in part by the Urological Research Foundation, Prostate SPORE grant and Robert H. Lurie Comprehensive Cancer Center grant
Close this window