Subclinical Haemostatic Activation And Current Surgeon Volume Predict Bleeding With Open Radical Retropubic Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 13 Sep 2008 - 1:00 PDT

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UroToday.com - Men with prostate cancer (CaP) are at greater risk of thromboembolic processes, but also can have a greater risk of bleeding. In the online version of the British Journal of Urology, Dr. Scott Tagawa reported on a series of patients undergoing radical prostatectomy RP) - primarily at the University of Southern California - and an assessment of plasma markers and clinical variables for bleeding and thrombosis.

Variables indicative of the activation of hemostasis included thrombin-antithrombin (TAT) complexes, fibrinopeptide A, D-dimers and prothrombin fragment F1+2. This study examined the association between predictive markers and other clinical variables and surgically related bleeding and thrombosis. In this study, 153 patients undergoing RP had preoperative blood counts collected and all samples were run in duplicate. Open RP with pelvic lymphadenectomy was performed by 6 different surgeons. Preoperative DVT prophylaxis was at the surgeon's discretion.

Most patients were low risk by D'Amico criteria. On RP pathology, 117 men (77%) had disease confined to the prostate and 36 men had extracapsular extension and/or lymph node metastasis. Warfarin was given to 72% of the patients for 1-6 days postoperatively. Eight men (5.2%) received blood transfusions. Only one man experienced a DVT, thus this analysis was not performed. A decreased TAT and D-dimer level correlated with lower postoperative hemoglobin levels, but not with EBL or the need for transfusion. Platelet counts, INR and PTT did not predict EBL nor decreases in hemoglobin. Those who had blood transfusions, however, had lower preoperative platelet counts. Pathological stage was not associated with any bleeding variable. Use of DVT prophylaxis was not associated with bleeding. Higher volume surgeons were associated with a lower EBL and decrease in hemoglobin, but no difference in transfusions. In multivariable analysis, TAT remained significantly associated with the change in hemoglobin, but D-dimer was no longer significant.

Thus, haemostatic activation before RP was associated with significantly less bleeding when assessed objectively.

Tagawa ST, Dorff TB, Rochanda L, Ye W, Boyle S, Raghavan D, Lieskovsky G, Skinner DG, Quinn DI, Liebman HA
BJU Int. 2008 Jul 29. (Epub ahead of print)

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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