Patients undergoing radical cystectomy for bladder cancer are at higher risk for thromboembolic events compared with the general population, and this elevated risk may persist for months after surgery, according to data from separate studies presented at the 38th Annual Congress of the European Association of Urology (EAU23) in Milan, Italy.
In a Swedish study comparing 8630 patients who underwent radical cystectomy with 79,040 matched cancer-free individuals randomly selected from the general population, investigators found that the cumulative incidences of myocardial infarction and ischemic stroke during the first postoperative year were 2.2% and 1.6%, respectively, in the radical cystectomy cohort compared with 1.3% and 1.1%, respectively, in the matched cohort.
Patients who underwent radical cystectomy had significant 7.5-fold and 5.2-fold higher odds of myocardial infarction and ischemic stroke during hospitalization, respectively, compared with the matched cohort. At 30 days from hospital discharge, the radical cystectomy group had a significant 1.8-fold increased risk for both myocardial infarction and ischemic stroke. At 90 days, the radical cystectomy group had a significant 1.4-fold increased risk for ischemic stroke and a nonsignificant 1.1-fold increased risk for myocardial infarction. At 1 year, the risks for both outcomes did not differ between the study arms.
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“Bladder cancer patients treated with radical cystectomy have an elevated risk for myocardial infarction and ischemic stroke during the first postoperative year,” said Johan Björklund, MD, PhD, of the Karolinska Institutet in Stockholm, Sweden, who presented study findings. “These risks are markedly higher during the index hospitalization, but then fall to the level of the background population around 3 to 6 months after surgery.”
In the other study, the same research team examined the risk for venous thromboembolic events among 8472 patients who underwent radical cystectomy and 77,260 matched randomly selected cancer-free individuals from the general population. The crude absolute risks for a pulmonary embolism at 30, 90, and 365 days after surgery were 1.1%, 1.8%, and 2.9%, respectively, in the radical cystectomy cohort and 0.02%, 0.06%, and 0.23%, respectively, in the matched cohort. At 30, 90, and 365 days, the radical cystectomy cohort had a significant 16.3-, 9.6-, and 5.2-fold increased risk for pulmonary embolism compared with the matched group, Dr Björklund reported.
For deep vein thrombosis (DVT), the risks were 0.85%, 2.4%, and 5.0%, respectively, in the radical cystectomy cohort and 0.03%, 0.08%, and 0.23%, respectively, in the matched cohort. At 30, 90, and 365 days, the radical cystectomy cohort had a significant 28.3-, 19.2-, and 7.8-fold increased risk for DVT, respectively, compared with the matched group.
“The occurrence of pulmonary embolism and DVT increase considerably in patients operated with radical cystectomy for bladder cancer and the risk remains elevated during the entire follow-up time,” Dr Björklund said. “This transient peak of incidence persists beyond standard extended postoperative thromboprophylaxis.”
References
Rautiola J, Björklund J, Zelic R, et al. The risk of arterial thromboembolic complications in bladder cancer patients after radical cystectomy—population-based nationwide matched cohort study. Presented at: EAU23, Milan, Italy, March 10-13, 2023. Abstract A0151.
Björklund J, Rautiola J, Zelic R, et al. The risk of venous thromboembolic events in patients operated with radical cystectomy—a nationwide population-based cohort study. Presented at: EAU23, Milan, Italy, March 10-13, 2023. Abstract A0152.
