67 Furthermore,

patients receiving ICD prophylaxis demonstrated a trend toward increased VTE rates. This study indicates that inpatient thromboprophylaxis may delay postoperative VTE without decreasing overall incidence. Similarly, in the @RISTOS study on VTE after urologic surgery, Scarpa and colleagues reported 6 cases of PE, 3 of which were fatal, occurring between 4 and 22 days postoperatively. 55 All patients had received at least pharmacologic prophylaxis postoperatively, with 4 receiving pharmacologic prophylaxis when the event occurred.55 Delayed versus early postoperative VTE is increasingly recognized as Inhibitors,research,lifescience,medical the rule rather than the exception in all surgical kinase inhibitor DAPT secretase disciplines. In a retrospective Inhibitors,research,lifescience,medical study of 5607 patients having undergone major hip

or knee surgery, the total rate of VTE was 2.7%. Patients presented with DVT and PE at a median of 24 and 17 days after surgery for hip fracture, 21 and 34 days after total hip replacement, and 20 and 12 days after total Inhibitors,research,lifescience,medical knee replacement, respectively. Overall, 70% of the VTE cases developed after discharge.84 The propensity of VTE to occur after the immediate perioperative period has led some to examine the efficacy of prolonged postoperative regimens of pharmacologic prophylaxis. In a double-blind, multicenter, placebocontrolled trial, Bergqvist and colleagues evaluated extending Inhibitors,research,lifescience,medical daily use of enoxaparin 40 mg SC beyond the initial 6- to 10-day postoperative period for an additional 21 days in patients undergoing surgery for cancer. 85 Patients were screened with bilateral venography between postoperative days 25 and 31 or sooner as clinically indicated. A total of 332 patients were evaluated. VTE rates were 12.0% and 4.8% in the placebo and treatment

arms, respectively. There were no increases in major or minor bleeding complications in the treatment group. In another study, Bergqvist and Jönsson demonstrated similar efficacy as well as cost effectiveness of prolonged Inhibitors,research,lifescience,medical postoperative administration of enoxaparin following total hip replacement.86 No such study has been performed specifically Cilengitide on urologic patients. However, the patient populations are similar and the results sufficiently convincing to warrant such a trial, if not application, in the urologic field. Clinical Manifestations and Treatment of VTE DVT Patients who develop DVT may complain of pain, swelling, or discoloration of the affected extremity. Physical examination may reveal a palpable cord, edema, warmth, and/or superficial vein dilatation due to collateralization of venous return from deep to superficial systems. The classic physical examination finding of resistance to passive dorsiflexion or Homan’s sign is neither sensitive nor specific and should not be used as a basis for clinical decision making.