Procedure-specific Risks of Thrombosis and Bleeding in Urological Non-cancer Surgery : Systematic Review and Meta-analysis

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Tikkinen , K A O , Craigie , S , Agarwal , A , Siemieniuk , R A C , Cartwright , R , Violette , P D , Novara , G , Naspro , R , Agbassi , C , Ali , B , Imam , M , Ismaila , N , Kam , D , Gould , M K , Sandset , P M & Guyatt , G H 2018 , ' Procedure-specific Risks of Thrombosis and Bleeding in Urological Non-cancer Surgery : Systematic Review and Meta-analysis ' , European Urology , vol. 73 , no. 2 , pp. 236-241 . https://doi.org/10.1016/j.eururo.2017.02.025

Title: Procedure-specific Risks of Thrombosis and Bleeding in Urological Non-cancer Surgery : Systematic Review and Meta-analysis
Author: Tikkinen, Kari A. O.; Craigie, Samantha; Agarwal, Arnav; Siemieniuk, Reed A. C.; Cartwright, Rufus; Violette, Philippe D.; Novara, Giacomo; Naspro, Richard; Agbassi, Chika; Ali, Bassel; Imam, Maha; Ismaila, Nofisat; Kam, Denise; Gould, Michael K.; Sandset, Per Morten; Guyatt, Gordon H.
Other contributor: University of Helsinki, Clinicum




Date: 2018-02
Language: eng
Number of pages: 6
Belongs to series: European Urology
ISSN: 0302-2838
DOI: https://doi.org/10.1016/j.eururo.2017.02.025
URI: http://hdl.handle.net/10138/231815
Abstract: Context: Pharmacological thromboprophylaxis involves a trade-off between a reduction in venous thromboembolism (VTE) and increased bleeding. No guidance specific for procedure and patient factors exists in urology. Objective: To inform estimates of absolute risk of symptomatic VTE and bleeding requiring reoperation in urological non-cancer surgery. Evidence acquisition: We searched for contemporary observational studies and estimated the risk of symptomatic VTE or bleeding requiring reoperation in the 4 wk after urological surgery. We used the GRADE approach to assess the quality of the evidence. Evidence synthesis: The 37 eligible studies reported on 11 urological non-cancer procedures. The duration of prophylaxis varied widely both within and between procedures; for example, the median was 12.3 d (interquartile range [IQR] 3.1-55) for open recipient nephrectomy (kidney transplantation) studies and 1 d (IQR 0-1.3) for percutaneous nephrolithotomy, open prolapse surgery, and reconstructive pelvic surgery studies. Studies of open recipient nephrectomy reported the highest risks of VTE and bleeding (1.8-7.4% depending on patient characteristics and 2.4% for bleeding). The risk of VTE was low for 8/11 procedures (0.2-0.7% for patients with low/medium risk; 0.8-1.4% for high risk) and the risk of bleeding was low for 6/7 procedures ( Conclusions: Although inferences are limited owing to low-quality evidence, our results suggest that extended prophylaxis is warranted for some procedures (eg, kidney transplantation procedures in high-risk patients) but not others (transurethral resection of the prostate and reconstructive female pelvic surgery in low-risk patients). Patient summary: The best evidence suggests that the benefits of blood-thinning drugs to prevent clots after surgery outweigh the risks of bleeding in some procedures ( such as kidney transplantation procedures in patients at high risk of clots) but not others ( such as prostate surgery in patients at low risk of clots). (C) 2017 European Association of Urology. Published by Elsevier B.V.
Subject: Baseline risk
Bleeding
Modeling
Reporting
Risk of bias
Thromboprophylaxis
Urology
Venous thromboembolism
THROMBOPROPHYLAXIS
THROMBOEMBOLISM
QUALITY
GRADE
3126 Surgery, anesthesiology, intensive care, radiology
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