When treating patients with cancer who experience an episode of

VTE, urologists should consider anticoagulation with LMWH for the initial 3 to 6 months of treatment before transitioning to warfarin. This approach has demonstrated significant reduction of recurrent VTE rates without increasing rates of major bleeding complications. However, no improvement in mortality was demonstrated Inhibitors,research,lifescience,medical with this regimen. Patients with 2 or more episodes of PE should be therapeutically anticoagulated indefinitely (Table 4).92 Table 4 Duration of Anticoagulation in Treatment of PE Conclusions VTE is a pervasive and dangerous pathologic entity in the field of urologic surgery. The propensity for PE to result in sudden postoperative death highlights the importance of prevention, rapid diagnosis, and

expedited treatment of this condition. Practicing urologists should have a thorough knowledge Inhibitors,research,lifescience,medical of the literature regarding prophylaxis against, as well as evaluation and treatment of, VTE so that they may use an evidence-based approach to management. The paucity of prospective clinical trials evaluating the safety and efficacy of pharmacologic prophylaxis Inhibitors,research,lifescience,medical in most major urologic surgeries forces us to extrapolate data from research in other surgical fields. This is Inhibitors,research,lifescience,medical SP600125 obviously suboptimal and indicates a pressing need for further urologic clinical research in this area. Main Points Venous thromboembolism (VTE) is a pervasive and potentially devastating complication of urologic surgery. The propensity for pulmonary embolism (PE) to result in sudden postoperative death highlights the

importance of prevention, rapid diagnosis, and expedited treatment of this condition. Urologists should be familiar with incidence rates, recommended prophylaxis, appropriate diagnosis, and treatment recommendations for VTE to minimize morbidity and mortality. The Inhibitors,research,lifescience,medical American Urological Association’s Best Practice Statement states that early ambulation is indicated for Nature Reviews Immunology low-risk patients undergoing minor procedures, mechanical or pharmacologic prophylaxis is suggested for moderate-risk patients undergoing higher-risk procedures, and both mechanical and pharmacologic prophylaxis is recommended for high-risk patients undergoing high-risk procedures-unless the risk of bleeding is unacceptably high. Treatment of VTE involves therapeutic anticoagulation for various lengths of time based on presence and reversibility of patient risk factors as well as number of events. Perioperative thromboprophylaxis should be considered in all major urologic surgeries. Studies have demonstrated the efficacy of thromboprophylaxis in preventing VTE.