Thromboprophylaxis in Urological Surgeries:A Review of Current Clinical Guidelines

Venous thromboembolism (VTE) is the most important non-surgical complication in patients undergoing major urological surgery. Pulmonary embolism is the most common cause of death after urological surgery. Several clinical practice guidelines have been presented in different countries to prevent VTE, reduce the risk of VTE, and minimize the risk of bleeding. In Iran, there is no local clinical guideline for the prevention of VTE in urological surgery patients. Therefore, the present study aimed to review the clinical guidelines available in the world regarding thromboprophylaxis in urological surgery patients and present a summary.

The latest version of all available clinical guidelines related to VTE prophylaxis in urological surgeries until 2022 was searched using Medline (by PubMed), Google Scholar, Embase, and Trip database. After selection, each clinical guideline was reviewed by two researchers and a summary of their recommendations was presented.

During the database search, four clinical guidelines were included in this study. Among the present guidelines, only the European Urological Association guideline was appropriate for patients undergoing urological surgery, and the other three guidelines were related to hospitalized patients or those who underwent other surgeries, which in some parts addressed urological patients. According to the guidelines, the prevention methods of VTE prophylaxis are mechanical and pharmaceutical.

The present study showed that there is only one clinical guideline that has provided specific recommendations for urological surgeries, and other clinical guidelines have not specifically addressed these patients. A review of the aforementioned guidelines (whether specific to urology patients or not) showed a dearth of evidence and research on urological surgery patients, and decision-making is not easily possible in many cases. The results of the present study can be a step for the adaptation and approval of valid global guidelines and their use in our country. Moreover, due to the lack of clinical guidelines in Iran, the summary of the recommendations of this study can be used for clinical purposes.