Surgical thromboprophylaxis in daily urologic surgery: Beyond bridge therapy

Abstract

Introduction: With the advanced laparoscopic and robotic surgery, thromboembolic prophylaxis in urologic procedures has traditionally been based on the experience of other surgical specialties. This paper aims to analyze the current recommendations, through a detailed study of the European clinical guidelines and bibliography, applying the recommendations of thromboprophylaxis to the daily urological practice.

Objectives: To elaborate general recommendations to surgical patients in Urology, avoiding the risk of perioperative thromboembolic events. Optimize medication in chronic patients and accurately classify who are eligible for bridge therapy.

Material and methods: A review of the available literature and the European clinical guidelines was carried out. We analyzed the most recent consensus articles by studying the available bibliography, trials and reviews on which the European guidelines for thromboprophylaxis in urology are based.

Results: Thromboembolic prophylaxis should be targeted towards surgeries that require abdominal approaches, prolonged bed rest or oncological pathologies. Bridge therapies with low molecular weight heparins should be limited. Patients undergoing treatment for chronic conditions can benefit from bridge therapies in specific cases.

Conclusions: According to the current guidelines, there might be an overuse of heparins in the daily clinical practice. The development of -direct oral- anticoagulants have shown to reduce the time to reintroduction of medication for chronic conditions as well as a more effective bleeding management.

Keywords: Anti-aggregation drug; Anticoagulant drug; Bridge therapy; Fármaco antiagregante; Fármaco anticoagulante; Hemorragia posquirúrgica; Postoperative hemorrhage; Prevención de riesgo; Risk prevention; Terapia puente; Thromboprophylaxis; Tromboembolismo venoso; Tromboprofilaxis; Venous thromboembolism.