Hemorrhagic and thrombotic complications following robotic-assisted prostatectomy (RALP) with risk-adapted antithrombotic prophylaxis: A retrospective study

Abstract

Background: Despite advances in robotic-assisted prostatectomy and enhanced postoperative rehabilitation protocols, approximately 20% of patients still experience complications - most frequently hemorrhagic. To evaluate the effect of discontinuing systematic PAP (pharmacologic anticoagulant prophylaxis) on postoperative complications - specifically hemorrhagic and thrombotic events - after robotic-assisted prostatectomy.

Methods: In this retrospective before-and-after study, 361 consecutive patients undergoing prostatectomy at a single center were included. Group I (n=173) received systematic PAP with low molecular weight heparin for 28 days postoperatively, alongside routine physical prophylaxis (early mobilization, adequate hydration, and intraoperative leg compression). Group II (n=188) received only routine physical prophylaxis. The primary endpoints were hemorrhagic and thrombotic complications.

Results: Clavien-Dindo≥II complications were significantly more frequent in Group I (20.2%) compared to Group II (12.2%, P<0.05). Hemorrhagic complications occurred in 10% of patients overall, with a significantly higher rate in Group I (15.0% vs. 3.7%, P<0.05). Thrombotic events were rare in both groups and not statistically different 2.3% vs. 3.7% (P=0.3). Thrombotic risk did not show a statistically significant difference in adjusted models with propensity score methods.

Conclusions: Our study suggest that systematic anticoagulation may increase hemorrhagic morbidity without a clear thrombotic benefit. These findings support a risk-adapted, individualized approach rather than routine pharmacologic thromboprophylaxis.

Keywords: Cancer de prostate; Extended prophylaxis; Prostate cancer; Prostatectomie totale; Prostatectomie voie robot-assistée; Radical prostatectomy; Robotic prostatectomy; Thromboprophylaxie; Tromboembolie veineuse; Venous thromboembolism.