Pathogenesis and Prophylaxis of Postoperative Thromboembolic Disease in Urological Pelvic Surgery

No AccessJournal of UrologyClinical Urology: Review Article1 Jun 1995Pathogenesis and Prophylaxis of Postoperative Thromboembolic Disease in Urological Pelvic Surgery Adam S. Kibel, and Kevin R. Loughlin Adam S. KibelAdam S. Kibel More articles by this author , and Kevin R. LoughlinKevin R. Loughlin More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)67302-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : The incidence of deep vein thrombosis after prostatectomy. Brit. J. Urol.1971; 43: 738. Google Scholar 2 : Prostatectomy and deep-vein thrombosis. Brit. J. Surg.1972; 59: 487. Google Scholar 3 : Prospective analysis of pulmonary embolism in the postoperative patient. Surgery1970; 68: 116. Google Scholar 4 : The prevention of fatal pulmonary emboli after prostatectomy. J. Urol.1948; 59: 920. Link, Google Scholar 5 : Natural history of pulmonary embolism. Prog. Cardiovasc. Dis.1975; 17: 259. Google Scholar 6 : Venous thromboembolism. Amer. Rev. Respir. Dis.1990; 141: 235. Google Scholar 7 : Natural history of postoperative deep-vein thrombosis. Lancet1969; 2: 230. Google Scholar 8 : The post-mortem incidence of pulmonary embolism in a hospital population. Brit. J. Surg.1968; 55: 347. Google Scholar 9 : Autopsy-verified pulmonary embolism at a surgical department: an analysis of the period 1951 to 1988. Brit. J. Surg.1991; 78: 849. Google Scholar 10 : Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis?. J. Roy. Soc. Med.1989; 82: 203. Google Scholar 11 : Prevention of venous thromboembolism in surgical patients. New Engl. J. Med.1974; 290: 93. Google Scholar 12 : Thromboembolic disease in the patient undergoing urologic surgery. Urol. Clin. N. Amer.1983; 10: 101. Google Scholar 13 : Prophylaxis of venous thromboembolism. An overview. Chest1986; 89: 374S. Google Scholar 14 Prevention of venous thrombosis and pulmonary embolism. J.A.M.A.1986; 256: 744. Google Scholar 15 : Venous thromboembolism. J. Urol.1989; 142: 1403. Link, Google Scholar 16 : Hematologic considerations in urologic surgery. In: Complications in Urologic Surgery: Prevention and Management. Edited by . Philadelphia: W. B. Saunders Co.1990: 41. chapt. 4. Google Scholar 17 : The epidemiology, pathogenesis, and natural history of venous thrombosis. In: Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Edited by . Philadelphia: J. B. Lippincott Co.1994: 1275. chapt. 65. Google Scholar 18 : Diagnosis of deep vein thrombosis. Review of clinical evaluation and impedance plethysmography. Amer. J. Surg.1985; 150: 7. Google Scholar 19 : Radical retropubic prostatectomy. In: . Philadelphia: W. B. Saunders Co.1992: 2865. chapt. 78. Google Scholar 20 : Perioperative and postoperative complications from bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. J. Urol.1987; 137: 1189. Link, Google Scholar 21 : Radical retropubic prostatectomy: morbidity and quality of life. Experience with 620 consecutive cases. J. Urol.1992; 147: 883. Link, Google Scholar 22 : Radical retropubic prostatectomy for localized prostatic carcinoma: a clinical and pathological study of 201 cases. Scand. J. Urol. Nephrol.1993; 27: 219. Google Scholar 23 : Radical retropubic prostatectomy: morbidity and urinary continence in 418 consecutive cases. Urology1994; 43: 47. Google Scholar 24 : Cystoprostatectomy and substitution cystoplasty for locally invasive bladder cancer. Brit. J. Urol.1992; 70: 40. Google Scholar 25 : Cystectomy and urinary diversion during twenty years--complications and metabolic implications. Eur. Urol.1993; 24: 343. Google Scholar 26 : Radical cystectomy for stages Ta, Tis and T1 transitional cell carcinoma of the bladder. J. Urol.1994; 151: 31. Link, Google Scholar 27 : Occurrence and course of thrombosis following prostatectomy. A phlebographic investigation. Acta Rad. Diagn.1970; 10: 513. Google Scholar 28 : The effect of the fibrinolytic inhibitor epsilon-aminocaproic acid on the incidence of deep-vein thrombosis after prostatectomy. Brit. J. Surg.1972; 59: 522. Google Scholar 29 : Prevention of postoperative deep-vein thrombosis by low-dose heparin in urological surgery. A double-blind, randomised study. Urol. Res.1977; 5: 123. Google Scholar 30 : Prophylactic mini-dose heparin in patients undergoing radical retropubic prostatectomy. A prospective trial. Urology1992; 34: 309. Google Scholar 31 : Is embolic risk conditioned by location of deep venous thrombosis? Ann. Intern. Med.1981; 94: 439. Google Scholar 32 : Diagnosis of deep venous thrombosis in the outpatient by venography. Surg., Gynec. & Obst.1980; 150: 69. Google Scholar 33 : The clinical significance of venous thrombosis of the calf. Brit. J. Surg.1976; 63: 377. Google Scholar 34 : Calf deep venous thrombosis. A wolf in sheep's clothing?. Arch. Intern. Med.1988; 148: 2131. Google Scholar 35 : Diagnosis efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial. Ann. Intern. Med.1985; 102: 21. Google Scholar 36 : Serial impedance plethysmography for suspected deep venous thrombosis in outpatients. The Amsterdam General Practitioner Study. New Engl. J. Med.1986; 314: 823. Google Scholar 37 : Detection of deep-vein thrombosis by real-time B-mode ultrasonography. New Engl. J. Med.1989; 320: 342. Google Scholar 38 : Perioperative prophylaxis of venous thromboembolism. Amer. J. Med. Sci.1993; 306: 336. Google Scholar 39 : The detection of venous thrombosis of the legs using 125-I-labelled fibrinogen. Brit. J. Surg.1968; 55: 742. Google Scholar 40 : Prophylaxis against venous thromboembolism in surgical patients. Amer. J. Surg.1991; 161: 507. Google Scholar 41 : Is there still an avoidable fraction of post-operative thromboembolic complications with heparin prophylaxis? The results of a case-control surveillance. Collaborative Group on Heparin Prophylaxis in Surgery (S.E.P.E.C). J. Clin. Epidemiol.1993; 46: 371. Google Scholar 42 : Never fall von todlicher emboli der lungeraterie. Arch. Path. Anat.1856; 10: 225. Google Scholar 43 : The prevention of deep vein thrombosis after surgery. Brit. J. Anaesth.1975; 47: 151. Google Scholar 44 : Venous thrombosis of the lower limbs with particular reference to bed-rest. Brit. J. Surg.1957; 45: 15. Google Scholar 45 : Venous thrombis and pulmonary embolism. A clinico-pathological study in injured and burned patients. Brit. J. Surg.1961; 48: 475. Google Scholar 46 : Deep venous thrombosis of the legs after strokes. Part I--incidence and predisposing factors. Brit. Med. J.1976; 1: 1178. Google Scholar 47 : On the mechanism of thrombosis. Prog. Hematol.1969; 6: 201. Google Scholar 48 : Blood-flow in deep veins of leg. Recording technique and evaluation of methods to increase flow during operation. Brit. J. Surg.1968; 55: 211. Google Scholar 49 : The effect of surgical operation on the velocity of venous return from the legs. J. Surg. Res.1970; 10: 513. Google Scholar 50 : Venous capacitance and outflow in the postoperative patient. Ann. Surg.1979; 190: 634. Google Scholar 51 : Serial phlebography of the normal lower leg during muscular contraction and relaxation. Acta Rad.1962; 57: 264. Google Scholar 52 : A modified radioactive fibrinogen test for diagnosing deep-vein thrombosis of the legs. Brit. J. Surg.1970; 57: 382. Google Scholar 53 : Soleal sinuses and stasis. Brit. J. Surg.1971; 58: 307. Google Scholar 54 : Natural anticoagulant mechanisms. J. Clin. Invest.1984; 74: 1. Google Scholar 55 : Identification in vitro of an endothelial cell surface cofactor for antithrombin III. Parallel studies with isolated perfused rat hearts and microcarrier cultures of bovine endothelium. J. Clin. Invest.1982; 69: 726. Google Scholar 56 : Isolation of a membrane-bound cofactor for thrombin-catalyzed activation of protein C. J. Biol. Chem.1982; 257: 859. Google Scholar 57 : The fibrinolytic system of the vascular wall. Clin. Haematol.1985; 14: 513. Google Scholar 58 : Activation of Hageman factor by collagen. J. Clin. Invest.1968; 47: 2608. Google Scholar 59 : Contributions of human platelets to the proteolytic activation of blood coagulation factors XII and XI. Blood1981; 57: 106. Google Scholar 60 : Venous stasis and vein lumen changes during surgery. Brit. J. Surg.1990; 77: 1055. Google Scholar 61 : Operative venodilation: a previously unsuspected factor in the cause of postoperative deep vein thrombosis. Surgery1989; 106: 301. Google Scholar 62 : Factor IX is activated in vivo by the tissue factor mechanism. Blood1990; 76: 731. Google Scholar 63 : Aging-associated changes in the indices of thrombin generation and protein C activation in humans. Normative Aging Study. J. Clin. Invest.1987; 80: 1527. Google Scholar 64 : Cancer procoagulant A: a factor × activating procoagulant from malignant tissue. Thromb. Res.1975; 6: 127. Google Scholar 65 : A study of proteins C and S in patients with prostatic disease. Letter to the Editor. Thromb. Haemost.1988; 60: 122. Google Scholar 66 : Hemostatic effects of hormonal stimulation in patients with metastatic prostate cancer. Amer. J. Hematol.1988; 28: 141. Google Scholar 67 : Clotting predisposition in carcinoma of the prostate. J. Urol.1980; 123: 706. Link, Google Scholar 68 : Platelet adhesiveness and lipoprotein lipase activity in patients with benign and malignant disease of the prostate. Brit. J. Surg.1972; 59: 60. Google Scholar 69 : The activation of coagulation by extracts of mucus: a possible pathway of intravascular coagulation accompanying adenocarcinomas. J. Lab. Clin. Med.1973; 82: 255. Google Scholar 70 : Fibrin formation on vessel walls in hyperplastic and malignant prostate tissue. Cancer1991; 67: 1377. Google Scholar 71 : Endotoxin enhances tissue factor and suppresses thrombomodulin expression of human vascular endothelium in vitro. J. Clin. Invest.1987; 79: 124. Google Scholar 72 : Tumor necrosis factor suppresses transcription of the thrombomodulin gene in endothelial cells. Mol. Cell Biol.1988; 8: 5588. Google Scholar 73 : Interleukin-1, endotoxin, or tumor necrosis factor/cachectin enhance the level of plasminogen activator inhibitor messenger RNA in bovine aortic endothelial cells. Thromb. Res.1989; 54: 41. Google Scholar 74 : Structure and function of thrombomodulin: a natural anticoagulant. Blood1990; 75: 329. Google Scholar 75 : Neutrophils and deep venous thrombosis. Haemostasis1993; 23: 127. Google Scholar 76 : Overview of the thrombotic process and its therapy. In: Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Philadelphia: J. B. Lippincott Co.1994: 1151. chapt. 57. Google Scholar 77 : Changes in blood coagulation and fibrinolysis during the postoperative period. Amer. J. Surg.1970; 119: 225. Google Scholar 78 : Alteration in fibrinolysis associated with surgery and venous thrombosis. Brit. J. Surg.1972; 59: 754. Google Scholar 79 : Relevance of preoperative and postoperative blood tests to postoperative leg-vein thrombosis. Lancet1973; 2: 805. Google Scholar 80 : Quantitative changes in platelet counts following major urological pelvic surgery. Eur. Urol.1993; 24: 350. Google Scholar 81 : Reduction in fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. Overview of results of randomized trials in general, orthopedic, and urologic surgery. New Engl. J. Med.1988; 318: 1162. Google Scholar 82 : Prevention of postoperative deep-vein thrombosis with perioperative subcutaneous heparin. Lancet1971; 2: 950. Google Scholar 83 : Efficacy of low doses of heparin in the prevention of deep-vein thrombosis after major surgery. A double-blind, randomised trial. Lancet1972; 2: 101. Google Scholar 84 Prevention of fatal postoperative pulmonary embolism by low doses of heparin. An international multicentre trial. Lancet1975; 2: 45. Google Scholar 85 : Rates of venous thrombosis after general surgery: combined results of randomised clinical trials. Lancet1986; 2: 143. Google Scholar 86 : Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann. Surg.1988; 208: 227. Google Scholar 87 : Controlled prevention of post-operative thrombosis in urological diseases with depot heparin. Eur. Urol.1975; 1: 229. Google Scholar 88 : Prevention of postoperative deep-vein thrombosis by low-dose heparin in open prostatectomy. Urol. Res.1980; 8: 219. Google Scholar 89 : Low dose heparin: bleeding and wound complications in the surgical patient. A prospective randomized study. Ann. Surg.1977; 186: 669. Google Scholar 90 : Subcutaneous heparin and postoperative wound hematomas. A prospective, double-blind, randomized study. Arch. Surg.1986; 121: 937. Google Scholar 91 : Hemorrhagic complications of anticoagulant treatment. Chest1992; 102: 352S. Google Scholar 92 : Anticoagulation in urologic surgery. Urology1977; 9: 617. Google Scholar 93 : Anticoagulants in open prostatectomies. J. Urol.1977; 117: 72. Abstract, Google Scholar 94 : Effect of mini-dose heparin on lymphocele formation following extraperitoneal pelvic lymphadenectomy. J. Urol.1980; 123: 890. Link, Google Scholar 95 : Complications of low-dose heparin prophylaxis following pelvic lymphadenectomy. Urology1986; 28: 21. Google Scholar 96 : Heparin-induced thrombocytopenia and thrombosis: clinical and laboratory studies. Brit. J. Haematol.1993; 84: 322. Google Scholar 97 : Heparin-induced thrombocytopenia. Haemostasis1986; 16: 173. Google Scholar 98 : Heparin-induced thrombocytopenia, thrombosis, and hemorrhage. Ann, Surg.1983; 198: 301. Google Scholar 99 : Heparin: mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest1992; 102: 337S. Google Scholar 100 : Glycosaminoglycans in urology. AUA Update Series1994; 13: 190. Google Scholar 101 : Low molecular weight heparins and external pneumatic compression as options for venous thromboembolism prophylaxis: a surgeon's perspective. Sem. Thromb. Hemost.1991; 17: 356. Google Scholar 102 : Prevention of venous thromboembolism. In: Hemostasis and Thrombosis: Basic Principles and Clinical Practice. Edited by . Philadelphia: J. B. Lippincott Co.1994: 1331. chapt. 68. Google Scholar 103 : Low-molecular-weight heparin versus standard heparin in general and orthopaedic surgery: a meta-analysis. Lancet1992; 340: 152. Google Scholar 104 : Orgaran (Org 10172) or heparin for preventing venous thrombosis after elective surgery for malignant disease? A double-blind, randomised, multicentre comparison. ANZ-Organon Investigators' Group. Thromb. Haemost.1993; 70: 562. Google Scholar 105 : Low molecular weight versus standard heparin for prevention of venous thromboembolism after major abdominal surgery. The Thromboprophylaxis Collaborative Group. Lancet1993; 341: 259. Google Scholar 106 : Prophylaxis of postoperative thromboembolism with low molecular weight heparins. Brit. J. Surg.1993; 80: 689. Google Scholar 107 : Dermatan sulphate: a safe approach to prevention of postoperative deep vein thrombosis. Brit. J. Surg.1992; 79: 505. Google Scholar 108 The Multicenter Trial Committee: Dihydroergotamine-heparin prophylaxis of postoperative deep vein thrombosis: a multicenter trial. J.A.M.A.1984; 251: 2960. Google Scholar 109 : A prospective comparison of thromboembolic stockings, external sequential pneumatic compression stockings and heparin sodium/dihydroergotamine mesylate for the prevention of thromboembolic complications in urological surgery. J. Urol.1991; 145: 1205. Link, Google Scholar 110 : Intermittent sequential pneumatic compression of the legs in the prevention of venous stasis and postoperative deep venous thrombosis. Surgery1980; 87: 69. Google Scholar 111 : Effect of intermittent compression of the arms on deep venous thrombosis in the legs. Lancet1976; 2: 1265. Google Scholar 112 : Pneumatic calf compression, fibrinolysis, and the prevention of deep venous thrombosis. Surgery1980; 88: 489. Google Scholar 113 : Thrombosis prophylaxis using external compression. Surg., Gynec. & Obst.1983; 156: 599. Google Scholar 114 : Pneumatic compression stockings and prostaglandin synthesis--a pathway of fibrinolysis? Crit. Care Med.1985; 13: 266. Google Scholar 115 : Intermittent sequential pneumatic compression of the legs and thromboembolism-deterrent stockings in the prevention of postoperative deep venous thrombosis. Surgery1983; 94: 21. Google Scholar 116 : Pneumatic compression devices for prophylaxis of deep venous thrombosis (DVT). Amer. Surg.1986; 52: 371. Google Scholar 117 : Regimen for improved effectiveness of intermittent pneumatic compression in deep venous thrombosis prophylaxis. Surgery1987; 102: 816. Google Scholar 118 : Effectiveness of intermittent pneumatic compression for preventing deep vein thrombosis after total hip replacement. J.A.M.A.1990; 263: 2313. Google Scholar 119 : Effect of optimization of hemodynamics on fibrinolytic activity and antithrombotic efficacy of external pneumatic calf compression. Ann. Surg.1987; 206: 636. Google Scholar 120 : Prevention of deep vein thrombosis in urological patients: a controlled, randomized trial of low-dose heparin and external pneumatic compression boots. Surgery1978; 83: 230. Google Scholar 121 : Intraoperative external pneumatic calf compression to afford long-term prophylaxis against deep vein thrombosis in urological patients. Surgery1980; 87: 239. Google Scholar 122 : Deep vein thrombosis and prostatectomy. Urology1983; 21: 461. Google Scholar 123 : Thromboembolic complications following radical retropubic prostatectomy: influence of external sequential pneumatic compression devices. Urology1993; 42: 406. Google Scholar 124 : The effect of intermittent pneumatic compression devices on intraoperative blood loss during radical prostatectomy and radical cystectomy. J. Urol.1993; 150: 1176. Link, Google Scholar 125 : Compression of the deep venous system of the lower leg during inactive recumbency. Arch. Surg.1973; 106: 38. Google Scholar 126 : Graduated compression stockings in the prevention of postoperative venous thromboembolism. A meta-analysis. Arch. Intern. Med.1994; 154: 67. Google Scholar 127 : A meta-analysis of methods to prevent venous thromboembolism following total hip replacement. J.A.M.A.1994; 271: 1780. Google Scholar 128 : Preoperative and postoperative anticoagulant prophylaxis to reduce fatal pulmonary embolism at a mixed surgical department. Acta Chir. Scand.1968; 134: 525. Google Scholar 129 : Prevention of fatal pulmonary embolism. Haemostasis1993; 23: 42. Google Scholar 130 : Anticoagulant, antithrombotic, and thrombolytic drugs. In: The Pharmacologic Basis of Therapeutics. Edited by . New York: MacMillan Publishing Co.1985: 1338. chapt. 58. Google Scholar 131 : Oral anticoagulants. Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest1992; 102: 312S. Google Scholar 132 : Prophylactic anticoagulant therapy in prostate surgery. Acta Chir. Scand.1966; 132: 444. Google Scholar 133 : A controlled investigation of the value of anticoagulation therapy in cases of prostatectomy. Scand. J. Urol. Nephrol.1976; 10: 39. Google Scholar 134 : Prospective randomized trial of warfarin and intermittent pneumatic leg compression as prophylaxis for postoperative deep venous thrombosis in major urologic surgery. J. Urol.1992; 147: 1056. Abstract, Google Scholar 135 : Prophylaxis of venous thromboembolism: analysis of cost effectiveness. Ann. Surg.1980; 191: 207. Google Scholar 136 : Bleeding during acetylsalicylic acid and anticoagulant therapy in patients with reduced platelet reactivity after aortic valve replacement. Amer. Heart J.1980; 99: 746. Google Scholar 137 : Trial of combined warfarin plus dipyridamole or aspirin therapy in prosthetic heart valve replacement: danger of aspirin compared with dipyridamole. Amer. J. Cardiol.1983; 51: 1537. Google Scholar 138 : Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Amer. J. Med.1989; 87: 144. Google Scholar 139 : Two-step warfarin therapy. Prevention of postoperative venous thrombosis without excessive bleeding. J.A.M.A.1983; 249: 374. Google Scholar 140 : Fixed minidose warfarin: a new approach to prophylaxis against venous thrombosis after major surgery. Brit. Med. J.1987; 295: 1309. Google Scholar 141 : Effects of fixed minidose warfarin on coagulation and fibrinolysis following major gynaecological surgery. Thromb. Haemost.1990; 64: 511. Google Scholar 142 : “Delayed” prophylactic anticoagulation: a study of results and complications in 2,012 total hip arthroplasties. J. Bone Joint Surg.1973; 55: 1487. Google Scholar 143 : A randomized trial of less intense postoperative warfarin or aspirin therapy in the prevention of venous thromboembolism after surgery for fractured hip. Arch. Intern. Med.1989; 149: 771. Google Scholar 144 : Protein C and the development of skin necrosis during anticoagulant therapy. Thromb. Haemost.1983; 49: 251. Google Scholar 145 : Necrosis of skin induced by coumadin in a patient deficient in protein S. Brit. Med. J.1989; 298: 233. Google Scholar 146 : Drug interactions with warfarin. Med. J. Aust.1992; 157: 479. Google Scholar 147 : Incidences of fatal postoperative pulmonary embolism after prophylaxis with dextran 70 and low-dose heparin: an international multicentre study. Brit. Med. J.1980; 280: 69. Google Scholar 148 : Prevention of thrombosis after pelvic surgery by British dextran 70. Lancet1972; 1: 614. Google Scholar 149 : Adverse reactions to dextran in Sweden 1970-79. Acta Chir. Scand.1983; 149: 253. Google Scholar 150 : The influence of aspirin on postoperative platelet kinetics and venous thrombosis. Surgery1975; 77: 61. Google Scholar 151 : Prevention of postoperative deep vein thrombosis with dipyridamole and aspirin. Brit. Med. J.1976; 1: 992. Google Scholar 152 : Aspirin and other platelet-active drugs. The relationship between dose, effectiveness, and side effects. Chest1992; 102: 327S. Google Scholar 153 : Analgesic-antipyretics and anti-inflammatory agents; drugs employed in the treatment of gout. In: The Pharmacological Basis of Therapeutics. Edited by . New York: Macmillan Publishing Co.1985: 674. chapt. 29. Google Scholar 154 : Prophylaxis of deep-vein thrombosis after total hip replacement. Dextran and external pneumatic compression compared with 1.2 or 0.3 gram of aspirin daily. J. Bone Joint Surg.1985; 67: 57. Google Scholar 155 : The prevention of deep vein thrombosis, with particular reference to mechanical methods of prevention. Surgery1977; 81: 228. Google Scholar 156 : Deep venous thrombosis: a continuing problem. Brit. Med. J.1988; 297: 28. Google Scholar 157 : The occurrence of late thromboembolic complications after elective abdominal surgery. Useskr Laeger1990; 152: 1586. Google Scholar 158 : Postoperative pulmonary embolism after hospital discharge: an underestimated risk. Arch. Surg.1992; 127: 310. Google Scholar 159 : Is there a need for long-term thromboprophylaxis following general surgery?. Haemostasis1993; 23: 10. Google Scholar 160 : The effects of low-dose heparin treatment on patients undergoing transvesical prostatectomy. Urol. Res.1981; 9: 147. Google Scholar 161 : Prospective development of a cost-efficient program for radical retropubic prostatectomy. Urology1994; 44: 311. Google Scholar 162 Prostate surgery expenses, 1991. Statistical Bull.1993; 74: 18. Google Scholar 163 : Venous thromboembolism after hospital discharge. Semin. Thromb. Hemost.1993; 19: 142. Google Scholar 164 : Long-term prophylaxis following orthopedic surgery. Haemostasis1993; 23: 27. Google Scholar Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts© 1995 by American Urological Association, and and of Pharmacological Prophylaxis for Venous Prevention in of Urology, and of Venous Prophylaxis in Urological and A and with American Urological for of Thromboembolic Prophylaxis American Urological of Urology, and C and of Venous Urological Cancer of Urology, A Complications of Pelvic in Radical Prostatectomy and of Urology, and A of Perioperative Radical of Urology, and C Is Heparin in Pelvic and Radical of Urology, S and A of Intermittent Pneumatic Compression of the Calf and in Deep Venous Thrombosis in Urological of Urology, and Loughlin of Urology, & 1995 by American Urological Association, Adam S. Kibel More articles by this author Kevin R. Loughlin More articles by this author All