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Thromboembolic events in patients undergoing neoadjuvant chemotherapy and radical cystectomy for muscle-invasive bladder cancer: a study of renal impairment in relation to potential thromboprophylaxis
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.ORCID iD: 0000-0001-7921-2425
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology. Department of Surgery, Urology Section, Sundsvall-Härnösand Hospital, Sundsvall, Sweden.
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2022 (English)In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 12, no 12, article id 1961Article in journal (Refereed) Published
Abstract [en]

Recent studies on patients with muscle-invasive bladder cancer (MIBC) undergoing neoadjuvant chemotherapy (NAC) have shown an association between NAC and thromboembolic events (TEE) prior to radical cystectomy (RC). Recent studies suggest that central venous access catheters (CVAs) may induce TEEs, and low-molecular-weight heparin (LMWH) has been mentioned as possible prophylaxis. However, other studies have shown a high incidence of decreased renal function in these patients. The purpose of this study was to determine the portion of MIBC patients with NAC-induced TEEs who had decreased preoperative renal function for whom LMWH potentially would not be beneficial as prophylaxis. We identified 459 cystectomized MIBC patients from two Swedish medical centers from 2009 to 2021. The inclusion criterion of cT2-T4aN0M0 resulted in 220 eligible patients, who were further divided into NAC-administered (n = 187) and NAC-eligible (n = 33), the tentative control group. Values of renal function before, during, and after each NAC cycle were retrospectively collected from individual medical records. Amongst the NAC-administered patients with TEE (n = 29), 41% (95% CI 23.5-61.1%) of patients had decreased renal function. Thus, a substantial portion of NAC-administered patients who developed TEEs had reduced renal function and would have been less likely to have benefited from renal clearance-dependent LMWH prophylaxis.

Place, publisher, year, edition, pages
MDPI, 2022. Vol. 12, no 12, article id 1961
Keywords [en]
complications, cystectomy, low-molecular-weight heparin, neoadjuvant therapy, thromboembolism, urinary bladder neoplasms
National Category
Urology and Nephrology
Identifiers
URN: urn:nbn:se:umu:diva-202123DOI: 10.3390/jpm12121961ISI: 000902481900001PubMedID: 36556181Scopus ID: 2-s2.0-85144652438OAI: oai:DiVA.org:umu-202123DiVA, id: diva2:1723121
Funder
Swedish Research CouncilRegion Västerbotten, Bas-ALF/VLL RV-848051Available from: 2023-01-02 Created: 2023-01-02 Last updated: 2023-09-26Bibliographically approved

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Eriksson, VictoriaSvensson, JohanBanday, Viqar ShowkatSherif, Amir

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