Risk Factors Analysis For Venous Thromboembolism In Patients After Transurethral Resection Of The Prostate(TURP)

Objective:To investigate the risk factors for Venous thromboembolism(VTE)in patients following transurethral resection of the prostate(TURP).To evaluate the clinical significance of mechanical prophylaxis in preventing the occurrence and development of VTE.To establish a reliable prediction model based on the screened risk factors,and further explore the influence of anticoagulant/antiplatelet drugs taken within a month before surgery on the occurrence of VTE after TURP.Methods:The clinical data of patients who received TURP surgery in the Department of Urology of Xiangya Hospital from January 2017 to December 2021 were retrospectively analyzed,and the collected clinical data included: age,body mass index,(BMI),history of hypertension,diabetes,chronic obstructive pulmonary disease,history of cardiovascular disease(e.g.,heart failure,coronary artery disease and cerebral infarction,etc.),history of varicose veins of lower limb,surgery history within a month,tumor history,VTE previous history,family history of VTE,history of preoperative presence of blood in the urine,history of urinary tract infections,history of anticoagulant/antiplatelet drugs within a month,outcome measurements during the perioperative period(such as prostate volume,creatinine,hemoglobin,D-dimer,TPSA),Caprini score,VTE related symptoms and diagnosis,such as postoperative lower limb vascular ultrasound,pulmonary artery CTA results),information related to the operation,whether to use mechanical prevention for VTE,and postoperative complications(such as the postoperative secondary bleeding,bladder neck contracture,urinary incontinence),etc.Logistic regression model and other statistical methods were used to analyze the independent risk factors for the occurrence and development of VTE after operation,and to explore the clinical significance of mechanical prevention.In addition,patients’ data were re-matched through the mechanism of propensity matching score and chi-square test was performed to explore whether the history of anticoagulant/antiplatelet drug use within a month had an impact on the occurrence and development of VTE after TURP.Results:A total of 576 patients were enrolled,including VTE 63(10.9%)and PE 4(0.69%).After univariate Logistic regression analysis,there were statistical differences among these factors including age,history of diabetes mellitus,previous history of VTE,family history of VTE,numerical changes of postoperative hemoglobin,postoperative D-dimer,Caprini score,surgical duration,whether mechanical preventive measures were taken,and the postoperative secondary bleeding.Multivariate stepwise Logistic regression analysis showed previous VTE history(a OR=12.342,95%CI=2.731-55.782),postoperative secondary bleeding(a OR=6.513,95%CI=2.394-17.721),D-dimer > 1.25mg/L(a OR=4.558,95%CI=1.413-14.699),age>65 years(a OR=3.483,95%CI=1.216-9.981)were independent risk factors for VTE.Mechanical preventive measures(a OR=0.289,95%CI=0.084-1.002)were protective factors for the occurrence and development of VTE after TURP.In addition,all patients were matched by propensity score,and 17 pairs of patients after TURP were screened out and divided into two groups according to whether they had taken anticoagulant/antiplatelet drugs within a month.Fisher’s exact probability method showed that there was no significant statistical difference in the incidence of VTE between the two groups(P=0.485).Conclusion:Many patients without obvious VTE symptoms after TURP may be lack of further screening,leading to the omission of VTE diagnosis.In fact,the incidence of VTE in patients after TURP is not low,as previously believed.Mechanical prophylaxis plays an active role in preventing the occurrence of VTE after TURP.It is of great significance to evaluate high-risk patients through risk factor analysis of VTE,so as to detect patients with VTE early and treat VTE early.According to the results of this study,taking anticoagulant/antiplatelet drugs within a month has no statistically significant effect on the occurrence and development of VTE after TURP,but the risk factors and protective factors for the occurrence and development of VTE after TURP still need to be verified by more prospective and high-quality research evidence.