2018 CUA GL preoperative DVT prophylaxis

Question 1

what is major bleeding as per CUA guideline?

Answer 1

bleeding requiring reoperation, embolization or causing death

Question 2

When they talk about use of VTE prophylaxis in CUA GL when do you start and finish?

Answer 2

morning after surgery for 28 days

Question 3

How does CUA GL define patient level risk stratification for DVT?

Answer 3

Age>75, BMI>35, VTE in first degree relative. ( moderate risk, if someone has 2 of those they are high risk . Personal history of VTE also high risk

Question 4

What is recommended for patients undergoing cystectomy?

Answer 4

Strong for medical PPX

Weak for mechanical PPX

Question 5

What do CUA consider to be a standard LND for radical prostatectomy?

Answer 5

node of cloquet, along the external iliac vein upto the bifurcation of ext and internal and obturator fossa

Question 6

What does CUA consider extended LND for prostatectomy?

Answer 6

Standard + going above bifurication of ext and internal, precaval, preaortic, presacral

Question 7

Someone having an open RP + no LND or standard LND. what DVT PPX?

Answer 7

Use medical DVT PPX

Use mechanical DVT PPX

Question 8

Someone having an open RP + extended LND. what DVT PPX?

Answer 8

Strong for medical DVT PPX

Use mechanical PPX

Question 9

Someone having a robotic/ lap RP + no LND. what DVT PPX?

Answer 9

NO medical DVT PPX

No mechanical DVT PPX ( unless they are moderate or high risk)

Question 10

Someone having a robotic/ lap RP + standard LND. what DVT PPX?

Answer 10

low/moderat risk no medical DVT ppx
high risk weak suggestion for medical ppx
mechanical ppx for all

Question 11

Someone having a robotic/ lap RP + extended LND. what DVT PPX?

Answer 11

low risk: no medical DVT PPX
moderate: Medical DVT PPX
High: strong for DVT PPX
Mechanical PPX for all

Question 12

What is recommended for patients having open renal surgery?

Answer 12

Weak evidence for DVT PPX and mechanical PPX

Question 13

What is the recommendation for patients having lap radical NX?

Answer 13

Low/moderate: weak against
High risk: weak for medical
Mechanical PPX for all

Question 14

What is the recommendation for patients having lap partial NX?

Answer 14

low/moderate risk: weak against
High risk: strong FOR!
mechanical for all

Question 15

What is the recommendation for patients having robotic partial NX?

Answer 15

low risk: weak against
moderate risk: weak for
high risk: strong for
mechanical for all

Question 16

What is the recommendation for patients having RPLND done?

Answer 16

Weak for medical

mechanical ppx

Question 17

What is recommended for patients having day surgery done?

Answer 17

NO medical or mechanical DVT PPX

Question 18

What is recommended for patients having TURP?

Answer 18

NO medical or mechanical DVT PPX

Question 19

What is recommended for donor nephrectomy, benign nephrectomy?

Answer 19

low/moderate risk: no medical or mechanical

High risk: medical and mechanical

Question 20

What is recommended for patients having prolapse or continence surgery done?

Answer 20

against use of

Question 21

Describe 6 groups of patients who are at very HIGH risk of thrombosis?

Answer 21

Drug elutting stent last 6 months, Bare metal stents last 6 weeks, TIA last 30 days, NEW VTE last 30 days, severe thrombophilia ( antithrombin def, antiphospholipid antibody), Cage ball mechanical heart valve

Question 22

What do you do if someone is on antiplatelet coming for surgery?

Answer 22

if not very high risk stop 7 days before and restart 4 days after, no bridging needed

Question 23

What is recommended for use of anticoagulants prior to surgery?

Answer 23

if not very high risk, stop before(DOACs: 3 days, LMWH 12 hours if BID, 24 hours if OD, Fondaprinux: 24 hour, warfarin: 5 days) and restart 4 days after

Question 24

What do you do for patients at very high risk of thrombosis coming for surgery?

Answer 24

delay surgery, if you cant get other specialties involved.