What is the most appropriate class of medication for Deep Vein Thrombosis (DVT) prophylaxis in a 59-year-old non-smoking man with a Body Mass Index (BMI) of 22 scheduled for Transurethral Resection of the Prostate (TURP)?

DVT Prophylaxis for TURP in a 59-Year-Old Non-Smoking Man with BMI of 22

For a 59-year-old non-smoking man with a BMI of 22 scheduled for TURP, early ambulation alone is the most appropriate prophylaxis against DVT, as this patient falls into a low-risk category without additional risk factors. 1

Risk Assessment

The patient's risk profile includes:

• Age 59 years (moderate risk factor) 1
• BMI of 22 (normal, not a risk factor) 1
• No smoking history (absence of risk factor) 1
• TURP procedure (low-risk urologic procedure) 1, 2

Risk Stratification

• According to the AUA Best Practice Statement, this patient falls into the moderate risk category (surgery in patients aged 40-60 years with no additional risk factors) 1
• For transurethral procedures specifically, the risk of DVT is very low, with studies showing an incidence of symptomatic VTE within 91 days of TURP of only 0.3-0.5% 1
• A retrospective study found that clinically evident thromboembolic complications following TURP are rare, with only 0.45% developing pulmonary emboli and 0.11% developing DVT 2

Recommended Prophylaxis

Primary Recommendation

• For transurethral procedures including TURP, early ambulation is recommended as the primary DVT prophylaxis method 1
• The American College of Chest Physicians guidelines support that for very low-risk patients (< 0.5% risk), no specific pharmacologic (Grade 1B) or mechanical prophylaxis (Grade 2C) is needed other than early ambulation 1

Alternative Options

For patients undergoing TURP who have additional risk factors (which this patient does not have), the following could be considered:

• Graduated compression stockings (GCS) 1
• Intermittent pneumatic compression (IPC) 1
• Pharmacologic prophylaxis with LDUH or LMWH 1

Clinical Considerations

Why Pharmacologic Prophylaxis Is Not Indicated

• The patient lacks high-risk features such as:
  • Advanced age (>60 years) 1
  • Active cancer 1
  • Previous history of VTE 1
  • Prolonged immobility 1
  • Hypercoagulable state 1

Potential Pitfalls

• Overuse of pharmacologic prophylaxis in low-risk patients can lead to unnecessary bleeding complications 1
• TURP procedures have specific bleeding concerns due to the prostatic vascular bed, making pharmacologic prophylaxis potentially more risky than beneficial in low-risk patients 1
• The risk of major bleeding with pharmacologic agents must be weighed against the very low risk of VTE in this patient population 1

Follow-up Recommendations

• Ensure early ambulation post-procedure 1
• Monitor for any signs or symptoms of DVT or PE 1
• If the patient's hospital course is prolonged or complications develop, reassess the need for additional prophylactic measures 1

In conclusion, for this specific patient profile (59-year-old non-smoker with normal BMI undergoing TURP), early ambulation alone represents the most appropriate approach to DVT prophylaxis, balancing the very low risk of thromboembolism against the potential bleeding risks of pharmacologic agents.