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" Long Term Thromboprophylaxis in Patients with Urologic Radical Pelvic Surgery "
\ Salman Eslami
; Mohamad Hosein Izadpanahi
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Isfahan University of Medical Sciences
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| Document Type
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Latin Dissertation
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| Language of Document
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English
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| Record Number
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109863
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| Doc. No
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T17356
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WJ161,E76l,2016
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| Main Entry
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Eslami, Salman
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| Title & Author
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Long Term Thromboprophylaxis in Patients with Urologic Radical Pelvic Surgery\ Salman Eslami
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| College
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Schools, Medical
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| Date
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, 2016
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| Degree
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Speciality
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| field of study
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Urology
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12 P.: tab
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| Note
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This is a research dissertation with project ID: 393890
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سلمان اسلامی
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| Abstract
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Introduction:Deep vein thrombosis (DVT) and Pulmonary Thromboembolism (PTE) , have long been recognized as serious and unfortunately common complications of surgery(1, 2).Venous thrombosis are highly preventable complications that occur during the postoperative period. Without perioperative treatment the risks of DVT (40% to 80%), PTE (4% to 10%) and fatal PTE (1% to 5%) are significantly increased(3). In particular, patients undergoing urological procedures are considered to be at an increased risk of VTE due to factors such as advanced age, the presence of malignancy, a history of neoadjuvant chemotherapy and/or the need for extensive pelvic dissection(4, 5). In such patients the risk of DVT and PTE without perioperative TP has been estimated at 33% and 1%, respectively(6, 7).As a result, preoperative thromboprophylaxis is an important aspect of prevention that improves perioperative outcomes in urological surgical patients.Incidence of thromboembolism event in patients undergoing urological surgery is variable. In a study in Portland, with aim of evaluating the timing, incidence and risk factors for venous thromboembolism for patients undergoing radical cystectomy, investigators have been shown that of 1,307 patients 78 (6%) were diagnosed with venous thromboembolism and risk factors for the development of venous thromboembolism were age , operative time and sepsis or septic shock(8).Also, pelvic surgery such as radical cystectomy or radical prostatectomyis associated with an increased risk of thrombosis, leading to the development of deep venous thrombosis (DVT) and pulmonary embolus (9). The routine use of thromboprophylactic measures is recommended for all abdominal and pelvic surgery, to the extent that some authors have suggested it is indefensible not to do so(10-12).Pharmacological measures routinely employed to reduce the risk of thrombotic events during pelvic surgery include the administration of low molecular weight heparin (LMWH), enoxaparin, tinzaparin (antifactorXa), aspirin, or warfarin (coumarin)(13, 14).Most urological surgeries, have a high risk of DVT or PE. In a study in USA, of 221 patients under radical cystectomy, about 14% identified with DVT Or PE(15).Additionally, high-level evidence suggests that extended post-operative prophylaxis is more effective than in-hospital prophylaxis alone.Some studies concluded that long term thromboprophylaxis is most effective than only hospital prophylaxis and short term thromboprophylaxis(16, 17).As a result, the aim of this study is comparison the effect of long term thromboprophylaxis, in thromboembolic event, DVT and PTE, in patients undergoing urologic radical pelvic surgery.Methods:This was a clinical randomized controlled trial, that conducted at a single center trial. Patients undergoing and were candidate for radical cystectomy and radical prostatectomy were included in the study and recruited. After checking for inclusion criteria, patients were enrolled to the study. They were included in the study if they had ages between 50 -70 years, normal coagulation status, no history of thromboembolic event, no history of bleeding disorders and if they don't have any metastatic disease. Also, sign an informed consent form was another inclusion criteria.Patients were excluded from study if, they had thromboembolic events during hospitalization after surgery and death of patients in each period of study.Participants were randomized to treatment or control groups through random table numbers. We enrolled 71 patients in intervention group and 68 patients in control group. After surgery, all patient in both groups, were treated with subcutaneous heparin 5000 IU injections every 12 hours until the end of hospitalization time. In the control group administration of subcutaneous heparin was stopped after discharge from hospitalization, but in the intervention group, administration of prophylactic anticoagulation continued (heparin) for 4 weeks after the operation.After 4 weeks, we compared the incidence of thromboembolic events (DVT and PTE) between two groups.Evaluation of PTE was down by presence of symptoms such as sudden apnea, tachypnea and sudden drop in blood pressure and for evaluation of DVT we noted to some symptoms such as Increase in limb circumference, difference in the legs size, edema, pain and stiffness in limbs.All data entered to SPSS software, version 18, and T student test, Chi square and Mann–Whitney U test were used to analysis the data.Results:Mean age of participants was 63/5 year, 97/2 % patients were male and 2l9 %were female.In total, 71 patients were recruited to intervention group and 68 patients in control group. According to type of surgery, 59 patient (42.4%) underwent in radical cystectomy and 80 participants (57.6%) underwent in radical prostatectomy.Frequency of thromboembolic events was 5 patients for PTE and 2 event for DVT.(Table 1)
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| Descriptor
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Urologic Surgical Procedures
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Venous Thrombosis
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Pulmonary Embolism
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| Added Entry
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Izadpanahi, Mohamad Hosein, Thesis advisor
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| Translated Title Supplied by Cataloguer
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تاثیر کاربرد آنتی کواکولانت پروفیلاکتیک پس از جراحی های رادیکال لگنی در جراحی های ارولوژی در کاهش حوادث ترومبوآمبولیک
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