Incidence, risk factors, and the role of anticoagulation therapy in venous thromboembolism following radical cystectomy

Abstract

Background: Radical cystectomy (RC) for bladder cancer is associated with substantial postoperative complications. Among these complications, venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is particularly notable for its morbidity. Efforts to reduce VTE have been largely revolving around extended thromboprophylaxis (ETP) after discharge, typically with injectable heparins, and, more recently, with oral anticoagulants. Objective: The purpose of this study was to quantify the incidence of VTE within 90 days following RC and to identify risk factors associated with its development. Methods: We conducted a retrospective review of all patients who underwent RC for bladder cancer at our institution between 2012 and 2024, documenting instances of postoperative VTE. Data on demographics, anticoagulation therapy, surgical approach, and hospitalization were collected and analyzed. Results: A total of 372 patients received RC for bladder cancer during the study. Of them, 12 patients (3.2%) developed VTE at some point after surgery. The median time to VTE occurrence was between 31 and 90 days post-discharge. A higher rate of VTE was observed immediately following RC in patients who underwent surgery before 2018 (p = 0.021), the year in which enhanced recovery after surgery (ERAS) protocols were implemented. Demographic factors and operation-related variables did not influence the VTE rate (p > 0.05). Kaplan-Meier analysis revealed that cancer-specific survival was significantly lower in patients who developed VTE after RC compared to those who did not (p < 0.001). Conclusion: These findings underscored the importance of interventions such as ETP and ERAS protocols in reducing the incidence of VTE following RC for bladder cancer.