Validating the role of ABO blood type in risk of perioperative venous thromboembolism after radical cystectomy
To validate the relationship between ABO blood type and risk of VTE post-RC in a large retrospective database.
Patients with urothelial bladder cancer (UBC) who underwent RC (intent-to-cure) for whom ABO blood type was available between 2003 and 2015 were identified from our IRB-approved database. VTE was defined as deep vein thrombosis (DVT) or pulmonary embolism (PE) within 90 days of surgery. VTE prophylaxis consisted of immediate postoperative Coumadin (2003–2009), unfractionated heparin (UFH) during hospitalization (2009–2015), and UFH during hospitalization plus 4 weeks of enoxaparin after discharge (2013–2015). Univariable and multivariable analyses of the association of ABO blood type with postoperative, symptomatic VTE and oncologic outcomes were performed.
Of 1341 patients, 595 (44.4%) were ABO type O and 746 (55.6%) were non-O (A, B and AB). 90 patients were diagnosed with VTE within 90 days of surgery (6.7%) (43% DVT-only, 57% PE ± DVT). On multivariable analysis non-O blood type was associated with a nearly twofold increased risk of VTE (OR = 1.94, 95% CI 1.215–3.098, p = 0.004). No difference in recurrence-free survival or overall survival was seen between ABO groups.
Non-O blood type is an independent, non-modifiable risk factor for postoperative VTE after RC. More comprehensive counseling and thromboprophylaxis should be considered in this high-risk group.
KeywordsMeSH Cystectomy Venous thromboembolism Urothelial carcinoma Bladder Thromboprophylaxis
SB: data management; data analysis; manuscript editing; other (critical review). KK: data collection or management; data analysis; manuscript writing/editing, STB: data collection or management; data analysis; manuscript writing/editing. GM: data collection or management; data analysis. JC: data collection or management; Data analysis. SD: protocol/project development; manuscript editing; other (critical review). HD: Protocol/project development; data management; data analysis; manuscript editing; other (critical review).
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflict of interest.
Research involving human participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.VanDlac AA, Cowan NG, Chen Y, Anderson RE, Conlin MJ, La Rochelle JC, Amling CL, Koppie TM (2014) Timing, incidence and risk factors for venous thromboembolism in patients undergoing radical cystectomy for malignancy: a case for extended duration pharmacological prophylaxis. J Urol 191(4):943–947. https://doi.org/10.1016/j.juro.2013.10.096 CrossRefGoogle Scholar
- 2.Alberts BD, Woldu SL, Weinberg AC, Danzig MR, Korets R, Badani KK (2014) Venous thromboembolism after major urologic oncology surgery: a focus on the incidence and timing of thromboembolic events after 27,455 operations. Urology 84(4):799–806. https://doi.org/10.1016/j.urology.2014.05.055 CrossRefGoogle Scholar
- 3.Agnelli G, Bolis G, Capussotti L, Scarpa RM, Tonelli F, Bonizzoni E, Moia M, Parazzini F, Rossi R, Sonaglia F, Valarani B, Bianchini C, Gussoni G (2006) A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the @RISTOS project. Ann Surg 243(1):89–95CrossRefGoogle Scholar
- 4.Kim SP, Shah ND, Karnes RJ, Weight CJ, Frank I, Moriarty JP, Han LC, Borah B, Tollefson MK, Boorjian SA (2012) The implications of hospital acquired adverse events on mortality, length of stay and costs for patients undergoing radical cystectomy for bladder cancer. J Urol 187(6):2011–2017. https://doi.org/10.1016/j.juro.2012.01.077 CrossRefGoogle Scholar
- 7.Duivenvoorden WC, Daneshmand S, Canter D, Lotan Y, Black PC, Abdi H, van Rhijn BW, Fransen van de Putte EE, Zareba P, Koskinen I, Kassouf W, Traboulsi SL, Kukreja JE, Boström PJ, Shayegan B, Pinthus JH (2016) Incidence, characteristics and implications of thromboembolic events in patients with muscle invasive urothelial carcinoma of the bladder undergoing neoadjuvant chemotherapy. J Urol 196(6):1627–1633. https://doi.org/10.1016/j.juro.2016.06.017 CrossRefGoogle Scholar
- 8.Tollefson MK, Karnes RJ, Rangel L, Carlson R, Boorjian SA (2014) Blood type, lymphadenectomy and blood transfusion predict venous thromboembolic events following radical prostatectomy with pelvic lymphadenectomy. J Urol 191(3):646–651. https://doi.org/10.1016/j.juro.2013.10.062 CrossRefGoogle Scholar
- 12.Brill A, Fuchs TA, Chauhan AK, Yang JJ, De Meyer SF, Köllnberger M, Wakefield TW, Lämmle B, Massberg S, Wagner DD (2011) von Willebrand factor-mediated platelet adhesion is critical for deep vein thrombosis in mouse models. Blood 117(4):1400–1407. https://doi.org/10.1182/blood-2010-05-287623 CrossRefGoogle Scholar
- 14.Gallinaro L, Cattini MG, Sztukowska M, Padrini R, Sartorello F, Pontara E, Bertomoro A, Daidone V, Pagnan A, Casonato A (2008) A shorter von Willebrand factor survival in O blood group subjects explains how ABO determinants influence plasma von Willebrand factor. Blood 111(7):3540–3545. https://doi.org/10.1182/blood-2007-11-122945 CrossRefGoogle Scholar
- 15.Nossent AY, van Marion V, van Tilburg NH, Rosendaal FR, Bertina RM, van Mourik JA, Eikenboom HC (2006) von Willebrand factor and its propeptide: the influence of secretion and clearance on protein levels and the risk of venous thrombosis. J Thromb Haemost 4(12):2556–2562. https://doi.org/10.1111/j.1538-7836.2006.02273.x CrossRefGoogle Scholar
- 17.Matsui T, Titani K, Mizuochi T (1992) Structures of the asparagine-linked oligosaccharide chains of human von Willebrand factor. Occurrence of blood group A, B, and H(O) structures. J Biol Chem 267(13):8723–8731Google Scholar
- 18.Dentali F, Sironi AP, Ageno W, Turato S, Bonfanti C, Frattini F, Crestani S, Franchini M (2012) Non-O blood type is the commonest genetic risk factor for VTE: results from a meta-analysis of the literature. Semin Thromb Hemost 38(5):535–548. https://doi.org/10.1055/s-0032-1315758 CrossRefGoogle Scholar
- 19.De Martino RR, Goodney PP, Spangler EL, Wallaert JB, Corriere MA, Rzucidlo EM, Walsh DB, Stone DH (2012) Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg. 55(4):1035–1040.e1034. https://doi.org/10.1016/j.jvs.2011.10.129 CrossRefGoogle Scholar
- 20.Mehrazin R, Piotrowski Z, Egleston B, Parker D, Tomaszweski JJ, Smaldone MC, Abbosh PH, Ito T, Bloch P, Iffrig K, Bilusic M, Chen DY, Viterbo R, Greenberg RE, Uzzo RG, Kutikov A (2014) Is extended pharmacologic venous thromboembolism prophylaxis uniformly safe after radical cystectomy? Urology 84(5):1152–1156. https://doi.org/10.1016/j.urology.2014.06.058 CrossRefGoogle Scholar
- 22.Tikkinen KA, Craigie S, Agarwal A, Violette PD, Novara G, Cartwright R, Naspro R, Siemieniuk RA, Ali B, Eryuzlu L, Geraci J, Winkup J, Yoo D, Gould MK, Sandset PM, Guyatt GH (2017) Procedure-specific risks of thrombosis and bleeding in urological cancer surgery: systematic review and meta-analysis. Eur Urol. https://doi.org/10.1016/j.eururo.2017.03.008 Google Scholar
- 24.Seng S, Liu Z, Chiu SK, Proverbs-Singh T, Sonpavde G, Choueiri TK, Tsao CK, Yu M, Hahn NM, Oh WK, Galsky MD (2012) Risk of venous thromboembolism in patients with cancer treated with Cisplatin: a systematic review and meta-analysis. J Clin Oncol 30(35):4416–4426. https://doi.org/10.1200/JCO.2012.42.4358 CrossRefGoogle Scholar
- 25.Gershman B, Moreira DM, Tollefson MK, Frank I, Cheville JC, Thapa P, Tarrell RF, Thompson RH, Boorjian SA (2016) The association of ABO blood type with disease recurrence and mortality among patients with urothelial carcinoma of the bladder undergoing radical cystectomy. Urol Oncol 34(1):4.e1-9. https://doi.org/10.1016/j.urolonc.2015.07.023 CrossRefGoogle Scholar
- 26.Klatte T, Xylinas E, Rieken M, Rouprêt M, Fajkovic H, Seitz C, Karakiewicz PI, Lotan Y, Babjuk M, de Martino M, Shariat SF (2014) Effect of ABO blood type on mortality in patients with urothelial carcinoma of the bladder treated with radical cystectomy. Urol Oncol 32(5):625–630. https://doi.org/10.1016/j.urolonc.2013.11.010 CrossRefGoogle Scholar
- 28.Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, Dietrich-Neto F, Investigators EI (2002) Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 346(13):975–980. https://doi.org/10.1056/NEJMoa012385 CrossRefGoogle Scholar
- 29.Pariser JJ, Pearce SM, Anderson BB, Packiam VT, Prachand VN, Smith ND, Steinberg GD (2017) Extended duration enoxaparin decreases the rate of venous thromboembolic events after radical cystectomy compared to inpatient only subcutaneous heparin. J Urol 197(2):302–307. https://doi.org/10.1016/j.juro.2016.08.090 CrossRefGoogle Scholar
- 30.Clément C, Rossi P, Aissi K, Barthelemy P, Guibert N, Auquier P, Ragni E, Rossi D, Frances Y, Bastide C (2011) Incidence, risk profile and morphological pattern of lower extremity venous thromboembolism after urological cancer surgery. J Urol 186(6):2293–2297. https://doi.org/10.1016/j.juro.2011.07.074 CrossRefGoogle Scholar