Persistent Hypercoagulability After Radical Prostatectomy: Biomarker Dynamics and Implications for Individualized Thromboprophylaxis

Venous thromboembolism (VTE) remains a clinically relevant complication of radical prostatectomy despite advances in surgical techniques and perioperative care. Current thromboprophylaxis strategies are largely based on fixed-duration approaches and static risk models focused on the early postoperative period. However, accumulating evidence suggests that postoperative hypercoagulability is a dynamic and prolonged process that may extend beyond this timeframe. This review summarizes the pathophysiological mechanisms and temporal dynamics of postoperative hypercoagulability after radical prostatectomy, with particular emphasis on biomarker-based evidence, including thrombin generation and von Willebrand factor. Clinical and laboratory findings suggest that haemostatic activation may persist after hospital discharge, supporting the concept of a biologically relevant post-discharge period during which insufficiently captured thrombotic risk may remain despite apparent clinical recovery. Current risk assessment models do not account for the time-dependent nature of postoperative haemostatic changes and do not incorporate biomarker data. This discrepancy highlights a gap between guideline-based thromboprophylaxis strategies and the underlying biological processes. To address this, we propose a conceptual framework in which postoperative thromboprophylaxis is considered in relation to the temporal evolution of hypercoagulability. This framework is hypothesis-generating and may help inform future studies aimed at identifying patients who could benefit from extended prophylaxis while avoiding unnecessary anticoagulation in those with more rapid haemostatic recovery. Further prospective studies are required to validate biomarker-guided strategies and to define clinically actionable thresholds for individualized thromboprophylaxis in prostate cancer patients undergoing radical prostatectomy.