Is Preoperative Anticoagulation in Nephrectomy with Caval Thrombectomy Necessary? A Multicenter Retrospective Cohort Study.

BACKGROUND AND

OBJECTIVE

Surgery of renal cell cancer (RCC) with a caval thrombus (CT) is associated with significant morbidity, particularly regarding thromboembolic complications. There are no data or recommendations regarding the potential benefit of preoperative anticoagulants. We aimed to assess the usefulness of preoperative anticoagulation regarding surgical outcomes and thromboembolic events in patients undergoing nephrectomy with inferior vena cava thrombectomy.

METHODS

We conducted a multicenter retrospective study of 216 patients who underwent surgery for RCC with a CT. Of these patients, 114 had preoperative anticoagulants. Intraoperative data and postoperative complications, particularly thromboembolic events, were compared between the two groups. To account for potential selection biases arising from nonrandom allocation of patients to different groups, we performed a propensity score-matched analysis.

KEY FINDINGS AND LIMITATIONS: There were more overall and major complications in the anticoagulation group, but the difference became nonsignificant after matching (odds ratio [OR] 1.58; 95% confidence interval or CI [0.76-3.26]; p = 0.17 and OR 1.83; 95% CI [0.68-4.96]; p = 0.21 respectively). Other pre- and postoperative parameters, particularly thromboembolic events, did not differ between the two groups. The main limitations are the retrospective design and the intercenter variability.

CONCLUSIONS AND CLINICAL IMPLICATIONS: The prescription of anticoagulation at the time of diagnosis of RCC with a CT does not appear to have any influence on the occurrence of thromboembolic events, while potentially increasing morbidity.

PATIENT SUMMARY: Surgery for kidney tumors with a caval thrombus is difficult and associated with a high rate of complications. One of the most feared complications is pulmonary embolism. Our study suggests that prescribing anticoagulants before surgery does not decrease the risk of embolism and could be responsible for an increased rate of complications.