Incidence of Venous Thromboembolism After Radical Prostatectomy: An Ultrasound Study by Grade Group

Venous thromboembolic events (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), are recognized complications following radical prostatectomy (RP). This study aimed to assess the incidence of VTE post-RP and to investigate the influence of Grade Group (GG) stratification and homegoing chemoprophylaxis on VTE risk. A retrospective review was conducted of 3,507 patients who underwent RP between 2015 and 2020 at a single institution, with GG assigned based on pre-operative biopsy. VTE screening was defined as patients undergoing DVT ultrasound or CT pulmonary embolism protocol within 90 days of surgery, with positive results indicating VTE. The electronic medical record was reviewed for prescriptions of homegoing VTE prophylaxis, including enoxaparin and apixaban. Among the 3,507 patients, 46 (1.3%) were diagnosed with VTE: 6 (0.7%) in GG1, 22 (1.5%) in GG2, 9 (1.4%) in GG3, 7 (2.2%) in GG4, and 2 (1.0%) in GG5 (p=0.3). A significant number of patients were discharged on VTE prophylaxis, with rates ranging from 42.6% in GG1 to 59.57% in GG5 (p<0.0001). Multivariate logistic regression revealed that homegoing VTE prophylaxis significantly reduced the risk of VTE (Odds Ratio [OR] 0.53, 95% Confidence Interval [CI] 0.28-0.97, p=0.04), while GG4 was the only group significantly associated with increased VTE risk (OR 1.62, 95% CI 1.10-10.46, p=0.03). Overall, the study found a low incidence of VTE following RP, with no significant differences across GGs, but highlights the importance of further prospective studies to examine the effects of post-discharge VTE prophylaxis.