AUTHOR REPLY

Abstract

We appreciate the Reviewer's thoughtful commentary, and completely agree that an update to the American Urological Association 2008 Best Practice Statement specifically to address the role of extended-duration pharmacologic prophylaxis (EDPP) should be considered. 1 Forrest JB Clemens JQ Finamore P et al. AUA best practice statement for the prevention of deep vein thrombosis in patients undergoing urologic surgery. J Urol. 2009; 181: 1170-1177 Crossref PubMed Scopus (89) Google Scholar Indeed, 3 randomized trials have shown a benefit of EDPP following abdominopelvic cancer surgery (refs. 10-12 in article), and these data have been corroborated by multiple retrospective series of patients undergoing radical cystectomy (RC) (refs. 13-16 in article). On the basis of these data, use of EDPP for 4 weeks following RC is currently endorsed by the European Association of Urology guidelines. 2 Tikkinen KAO, Cartwright R, Gould MK, et al. Thromboprophylaxis guideline panel. EAU Guidelines of thromboprophylaxis in urological surgery. Retrieved from: https://uroweb.org/guideline/thromboprophylaxis/. Accessed date 28 October 2019. Google Scholar While we acknowledge that a randomized trial exclusively comprised of RC patients would be ideal to inform this issue, clinical equipoise suggests that given the state of the existing data, as well as the potential morbidity and increased costs known to be associated with postoperative venous thromboembolism, adoption of this practice is warranted, particularly in light of the time and expense likely required to complete such a trial.