AUA issues best practice policy on deep vein thrombosis

January 29, 2009

AUA has released a best practice policy statement on the prevention of deep vein thrombosis (DVT) in patients undergoing urologic surgery.

AUA has released a best practice policy statement on the prevention of deep vein thrombosis (DVT) in patients undergoing urologic surgery. This is the first time AUA has released official guidance on the prevention of postoperative blood clot formation.

The full document is available at www.AUAnet.org.

“Deep vein thrombosis 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,” said AUA Practice Guidelines Committee Chair John B. Forrest, MD, who also led the expert panel that developed the statement.

The panel concluded that, depending on the level of patient risk for thromboembolism, the following therapies can be used alone or in combination to prevent DVT in the surgical setting:

• mechanical: early ambulation, graduated compression stockings, and intermittent pneumatic compression
• pharmacologic: low-dose unfractionated heparin and low molecular weight heparin (risk of bleeding complications should be considered).

The combination of mechanical and pharmacologic prevention strategies has been demonstrated in non-urologic procedures to be superior to either modality alone.

In addition, the panel identified four categories of urologic surgeries for which DVT prophylaxis is appropriate: transurethral surgery, anti-incontinence and pelvic reconstructive surgery, laparoscopic urologic and/or robotically assisted laparoscopic procedures, and open urologic surgery. Recommendations for each are provided in the statement.