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Preventing Blood Clots After Radical Prostatectomy

Preventing Blood Clots After Radical Prostatectomy

They don’t happen often, but Brady urologists would like to prevent them altogether: blood clots in the legs or lungs after radical prostatectomy.

A new study, led by Brady Chief Resident Hiten Patel, M.D., M.P.H., and directed by Mohamad Allaf, M.D., Vice Chairman and Professor of Urology, has shown that a blood-thinning drug, heparin, given subcutaneously (under the skin), can help – and, importantly, that it doesn’t cause extra problems.

For half a century, Patel notes, subcutaneous heparin has gotten a bad rap: “Many urologists in the U.S. have been wary of subcutaneous heparin, because of early reports that it might increase the rate of lymphoceles (buildup of lymphatic fluid in the pelvis) after radical prostatectomy. But Patel and Allaf thought heparin deserved another look, and Patel has just completed the largest-ever prospective randomized trial, assessing the impact of subcutaneous heparin in 500 men who underwent radical prostatectomy at Johns Hopkins. The trial is called PREVENTER (PREvention of VENous ThromboEmbolism Following Radical Prostatectomy).

“We found that the rate of symptomatic blood clots (those felt by the patient, usually due to pain or swelling in the legs) after radical prostatectomy is already very low, at about 2 percent, without using subcutaneous heparin,” says Patel. “While not statistically significant, subcutaneous heparin further reduced the rate of blood clots by about 1 percent.” The scientists also screened for asymptomatic blood clots – clots too small for the patient to feel – using Duplex ultrasound in about one-third of patients.

“Most importantly, we did not observe any increase in adverse events or bleeding,” Patel continues. “The occurrence of symptomatic lymphoceles was the same, regardless of whether patients received subcutaneous heparin or not. Our findings suggest it is safe to give subcutaneous heparin around the time of radical prostatectomy,” and this may be most beneficial for men at higher risk, including those with blood disorders or a history of blood clots.

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