Perioperative use of venous thromboembolism prophylaxis following major urologic oncology surgeries: A survey of the Society of Urologic Oncology.

INTRODUCTION

Venous thromboembolism (VTE) is a significant concern following radical cystectomy (RC) and other major urologic oncologic surgeries. In a 2019 survey of the Society of Urologic Oncology (SUO), 80% of respondents reported using extended VTE prophylaxis (EP), usually enoxaparin, though many cited financial concerns, poor compliance, and administration difficulty as barriers. We hypothesize that practice patterns may have changed since the adoption of apixaban for EP, and aim to describe current practices for RC and other oncologic surgeries, as well as compare barriers to both forms of EP.

METHODS

A survey of SUO members was conducted between August and September 2023. Participants reported their EP practices following RC, retroperitoneal lymph node dissection (RPLND), robotic-assisted laparoscopic prostatectomy (RALP), and nephrectomies. Demographic and practice data were analyzed alongside trends in EP usage, preferred agents, and barriers to adoption.

RESULTS

Sixty-two SUO members (6% response rate) completed the survey. EP use after RC increased from 80% in 2019 to 98% (P < 0.001), with 70% now prescribing apixaban compared to 0% previously. Other urologic procedures, such as RPLND and RALP, saw EP usage in only ∼30% of cases. Enoxaparin was reported as less favored due to patient compliance issues, while apixaban faced challenges with cost and insurance coverage. Cost aids, such as manufacturer coupons, were noted as helpful in reducing apixaban's financial barriers.

CONCLUSIONS

EP after RC has increased substantially, with apixaban emerging as the preferred agent. However, usage remains limited for other urologic procedures, reflecting variability in perceived VTE risk. Barriers such as cost and accessibility persist but may be alleviated by the introduction of generic apixaban. Efforts to address these barriers are crucial for optimizing VTE prevention across urologic oncology.