LINTHICUM, MD, January 14, 2009--The American Urological Association (AUA) today released a Best Practice Policy Statement for the Prevention of Deep Vein Thrombosis (DVT) for Patients Undergoing Urologic Surgery. This is the first time the AUA has released official guidance on the prevention of post-operative blood clot formation, a common – but serious and potentially fatal – complication of many surgical procedures. Because DVT is a common concern among surgeons in all specialties and, in a number of cases highly preventable with prophylaxis, it is essential that urologists have a clear understanding of the appropriate measures to minimize the risk of DVT.
“Deep vein thrombosis (DVT) and its potential sequelae of pulmonary thromboembolism is one of the most common postoperative complications of urologic surgery. It is also one of the most preventable. It is extremely important for all urologic surgeons to consider each patient's DVT risk at the time of surgery and in the post operative period along with the appropriate DVT prophylaxis,” said AUA Practice Guidelines Committee Chair John B. Forrest, MD, who also led the expert panel that developed the statement.
The new AUA statement is based on panel review of all available professional literature, members’ clinical experience and expert opinion. Unlike a clinical guideline, best practice policy statements do not employ formal meta-analysis of the literature. The new statement is currently available online at www.AUAnet.org.
DVT occurs when a blood clot forms in a “deep vein,” a major blood vessel deep within the body carrying non-oxygenated blood to the heart. Clot formation can be problematic if the clot blocks the blood vessel (thrombosis) or if it travels to another part of the body (embolism). Pulmonary thromboembolism – which occurs when a blood clot moves into and blocks the pulmonary artery carrying blood to the lung for oxygenation – can be fatal if not treated promptly. There are a number of different approaches to preventing the complication that are dependent on two primary considerations: patient risk factors and the inherent risks of the procedure being performed.
The Panel concluded that, depending on the level of patient risk for thromboembolism, the following therapies can be used alone or in combination as options for the prevention of DVT in the surgical setting:
• mechanical (nonpharmacologic) therapies: early ambulation, graduated compression stockings (GCS), and intermittent pneumatic compression (IPC)
• pharmacologic agents: low-dose unfractionated heparin (LDUH) and low molecular weight heparin (LMWH)
Additionally, the combination of mechanical and pharmacologic prevention strategies has been demonstrated in non-urologic procedures to be superior to either modality alone. When considering the pharmacologic options, the risk of bleeding complications should be considered.
The Panel also identified four categories of urologic surgeries that appeared to be candidates for DVT prophylaxis: transurethral surgery, anti-incontinence and pelvic reconstructive surgery, laparoscopic urologic and/or robotically assisted laparoscopic procedures, and open urologic surgery. The Panel made recommendations for each of the four urologic surgeries; recommendations can be found in the full statement, located online at www.AUAnet.org. The full statement will be published in the March issue of the Journal of Urology®.
The Panel that developed the Best Practice Statement was chaired by John B. Forrest, MD. Other physician members included J. Quentin Clemens, MD, Peter Finamore, MD, Raymond Leveillee, MD, Marguerite Lippert, MD, Louis Pisters, MD, Karim Touijer, MD and Kristine Whitmore, MD. Linda E. Whetter, DVM, PhD, served as a consultant.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 16,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
Lacey Dean, AUA