EDITORIAL COMMENT

Abstract

The authors have conducted informative and important health services research on the “trends in extended-duration pharmacological prophylaxis (EDPP) to prevent venous thromboembolism (VTE) following radical cystectomy (RC)” using the national administrative claims database for the period 2012-2017. 1 URL-D-19-01447R1. 2019. Google Scholar Allowing for limitations of methodology using such databases, it was notable that a low proportion (19%) of cases received EDPP overall in the study period. Encouragingly, there was an improving time-trend from 9% utilization in 2012 to 26% in 2017. However, given that VTE following radical abdominal and/or pelvic surgery for cancer is a major cause of morbidity, mortality and cost, the findings of the current study portray an unfavorable picture for the current state of clinical practice with respect to EDPP utilization. Indeed, provided there are no contraindications, most international and/or national guidelines recommend the use of EDPP in this setting for high-risk cases. 2 Tikkinen KAO Craigie S Agarwal A et al. Procedure-specific risks of thrombosis and bleeding in urological cancer surgery: systematic review and meta-analysis. Eur Urol. 2018; 73: 242-251 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar ,3 Key NS Bohlke K Falanga A Venous thromboembolism Prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update summary. J Oncol Practice. 2019; (Jop1900368) Crossref PubMed Scopus (19) Google Scholar The AUA Best Practice Statement from 2008 highlights the importance of thromboprophylaxis following RC, amongst other urological procedures, but falls short of touching upon the subject of EDPP in that context. 4 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 (90) Google Scholar However, the evidence is accumulating to issue clear guidelines in support of EDPP, particularly as over 50% of symptomatic VTEs occur after discharge from hospital. 5 Sagalovich D Say R Kaouk J Mehrazin R The role of extended venous thromboembolism prophylaxis following urologic pelvic surgery. Urol Oncol. 2018; 36: 83-87 Crossref PubMed Scopus (5) Google Scholar , 6 VanDlac AA Cowan NG Chen Y et al. Timing, incidence and risk factors for venous thromboembolism in patients undergoing radical cystectomy for malignancy: a case for extended duration pharmacological prophylaxis. J Urol. 2014; 191: 943-947 Crossref PubMed Scopus (76) Google Scholar , 7 Kukreja JE Levey HR Scosyrev E et al. Effectiveness and safety of extended-duration prophylaxis for venous thromboembolism in major urologic oncology surgery. Urol Oncol. 2015; 33 (387.e387-316) Crossref PubMed Scopus (35) Google Scholar Lower compliance to EDPP use may in part be due to underappreciation of the risks in the absence of clear guidelines. 8 Sterious S Simhan J Uzzo RG et al. Familiarity and self-reported compliance with american urological association best practice recommendations for use of thromboembolic prophylaxis among american urological association Members. J Urol. 2013; 190: 992-998 Crossref PubMed Scopus (40) Google Scholar By highlighting the current trends in EDPP utilization after RC, the current study provides opportunities to look more closely into this issue and update the guidelines in relation to EDPP use following major urological oncological surgery, including RC.