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| Prevention of thromboembolic events after radical prostatectomy in patients with hereditary thrombophilia due to a factor V Leiden mutation by multidisciplinary coagulation management |
Randi M. Posea,*( ),Sophie Knippera,Jonas Ekrutta,Mara Kölkera,b,Pierre Tennstedta,Hans Heinzera,Derya Tilkia,b,Florian Langerc,Markus Graefena
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aMartini-Klinik Prostate Cancer Centre, University Hospital Hamburg-Eppendorf, Germany
bDepartment of Urology, University Hospital Hamburg-Eppendorf, Germany
cDepartment of Hematology and Oncology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany |
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Abstract Objective: To examine the perioperative impact of factor V Leiden mutation on thromboembolic events' risk in radical prostatectomy (RP) patients. With an incidence of about 5%, factor V Leiden mutation is the most common hereditary hypercoagulability among Caucasians and rarer in Asia. The increased risk of thromboembolic events is three- to seven-fold in heterozygous and to 80-fold in homozygous patients. Methods: Within our prospectively collected database, we analysed 33 006 prostate cancer patients treated with RP between December 2001 and December 2020. Of those, patients with factor V Leiden mutation were identified. All patients received individualised recommendation of haemostaseologists for perioperative anticoagulation. Thromboembolic complications (deep vein thrombosis and pulmonary embolism) were assessed during hospital stay, as well as according to patient reported outcomes within the first 3 months after RP. Results: Overall, 85 (0.3%) patients with known factor V Leiden mutation were identified. Median age was 65 (interquartile range: 61-68) years. There was at least one thrombosis in 53 (62.4%) patients and 31 (36.5%) patients had at least one embolic event in their medical history before RP. Within all 85 patients with factor V Leiden mutation, we experienced no thromboembolic complications within the first 3 months after surgery. Conclusion: In our cohort of patients with factor V Leiden mutation, no thromboembolic events were observed after RP with an individualised perioperative coagulation management concept. This may reassure patients with this hereditary condition who are counselled for RP.
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Received: 10 September 2021
Available online: 20 January 2024
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Corresponding Authors:
*E-mail address: r.pose@uke.de (R.M. Pose).
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| Characteristic | Value | | Agea, year | 65 (61-68) | | Preoperative PSAa, ng/mL | 6.8 (4.3-10.0) | | BMIa, kg/m2 | 25.4 (23.8-28.8) | | Surgical techniqueb | | RARP | 34 (40.0) | | ORP | 51 (60.0) | | Operation timea, min | 185.2 (153.5-210.0) | | Intraoperative blood lossa, mL | 500 (300-800) | | PLNDb | 74 (87.1) | | Dissected lymph nodea | 12 (5-19) | | Postoperative Gleason scoreb | | ≤3+3 | 7 (8.2) | | 3+4 | 50 (58.8) | | 4+3 | 14 (16.5) | | ≥4+5 | 14 (16.5) | | pT-statusb | | ≤T2c | 48 (56.5) | | T3a | 23 (27.1) | | T3b | 13 (15.3) | | T4 | 1 (1.2) | | pN-statusb | | N0 | 62 (72.9) | | N1 | 12 (14.1) | | Nx | 11 (12.9) | | Hospitalisation timea, day | 8 (7?8) | | Preoperative Hba, g/dL | 14.4 (13.9-15.1) | | Delta Hba, g/dL | 2.6 (1.5-3.5) | | Preoperative apTTa, s | 29.6 (27.0-31.6) | | Follow-upa, month | 30.8 (8.2-69.8) |
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Basic patient characteristics of the 85 factor V Leiden mutation patients who underwent radical prostatectomy.
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| FVM | Patient, n | Pre-existing oral anticoagulation | Use of TA | VT/embolia | Relevant comorbidity | Peri- or post-operative anticoagulation or thrombosis prophylaxis regimen (number of patients) | | Homo | 1 | y (P) | n | y/n | AF, VT | 1×40, 2×40, 1×100, P (1) | | Hetero | 50 | n | n | n | n | 1×40, 4 w (2) | | n | n | n | n | 1×40, 5 w (5) | | n | n | n | STP | 1×40, 5 w (1) | | n | n | n | Prothrombin mutation | 1×40, 5 w (1) | | n | n | n | Factor VII deficiency | 1×40, 5 w (1) | | n | n | y/n | n | 1×40, 5 w (3) | | n | n | y/y | n | 1×40, 5 w (2) | | n | y | n/y | n | 1×40, 4 w (1) | | n | y | n | NA | 1×40, 4 w (3) | | n | n | y/y | n | 1×40, 1×80, 4 w (1) | | y (P) | n | n/y | AF | 1×40, P (1) | | y (P) | n | n/y | Factor VIII elevation | 1×40, 2×40, P (1) | | y (DOAC) | n | n/y | n | 1×40, 2×40, DOAC (1) | | y (P) | n | n/y | n | 1×40, 2×40, 1×80, P (1) | | n | n | y/y | Protein S deficiency | 1×40, 2×40, 1×80, 5 w (1) | | n | y | y/y | NA | 1×40, 2×40, 5 w (1) | | n | n | y/n | n | 1×40, 2×50, 5 w (1) | | n | n | y/y | n | 1×40, 2×40, 5 w (2) | | n | n | y/n | 1 with Protein S deficiency | 1×40, 2×40, 1×80, (3) | | y (P) | n | y/n | n | 1×40, 2×40, 1×80, P (7) | | y (DOAC) | n | y/n | n | 1×40, 2×40, 1×80, DOAC (7) | | y (P) | n | y/y | n | 1×40, 2×40, 1×80, P (2) | | y (DOAC) | n | y/y | n | 1×40, 2×40, 1×80, DOAC (2) | | NA | 34 | n | n | n | n | NA (3) | | n | n | y/n | n | NA (2) | | n | n | y/y | n | 1×40, 4 w (1) | | y (P) | n | y/y | n | 1×40, 2×100, P (1) | | y (P) | n | y/y | n | NA (1) | | n | n | n | n | 1×40, 4 w (5) | | n | y | n/y | PVO | 1×40, 4 w (1) | | n | y | y/y | CHD | 1×40, 4 w (1) | | n | n | n | n | 1×40, 5 w (2) | | n | n | y/n | n | 1×40, 2×40 (3) | | y (P) | n | n | AF | 1×40, 2×40, P (1) | | y (P) | n | y/y | n | 1×40, 2×40, P (1) | | y (P) | n | n/y | n | 1×40, 2×60, P (1) | | y (P) | n | y/y | n | 1×40, 1×80, P (1) | | y (P) | n | y/n | n | 1×40, 1×60, P (1) | | y (P) | n | y/y | n | 1×40, 2×40, 1×80, P (3) | | y (P) | n | n/y | n | 1×40, 2×40, 1×80, P (1) | | y (DOAC) | n | y/y | CHD | 1×40, 2×40, DOAC (1) | | y (DOAC) | n | y/y | n | 1×40, 2×40, 1×80, DOAC (1) | | y (DOAC) | n | y/n | n | 1×40, 2×40, 1×80, DOAC (1) | | y (DOAC) | n | y/y | n | 1×60, 2×60, DOAC (1) | | n | y | y/n | n | 1×40, 2×40, 1×80, 6 w; DOAC recommended (1) |
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Factor V Leiden mutation patients (n=85) who underwent radical prostatectomy: distribution of the underlying factor V mutation, pre-existing oral anticoagulation, use of TA, previous thromboembolic diseases, previous diseases of importance to the physiology of coagulation, coagulation management concept determined by a haematologist in consultation.
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