Trends in Adherence to Thromboprophylaxis Guideline in Patients Undergoing Radical Cystectomy

Tully, Karl; Krimphove, Marieke J.; Reese, Stephen W.; Kibel, Adam S.; Noldus, Joachim; Krasnow, Ross; Trinh, Quoc‐Dien; Sonpavde, Guru; Mossanen, Matthew

doi:10.1016/j.urology.2019.09.029

Cited by 5 publications

(3 citation statements)

References 27 publications

(39 reference statements)

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“…Recent rates of VTE have either been rising or stable in the United States (14–16), China (17,18), Norway (19), Sweden (20), and Alberta (21), a Canadian province with similar population and health care delivery to Manitoba. In 1 urological study, despite guidelines advocating for thromboprophylaxis after radical cystectomy, the use of thromboprophylaxis in that setting was underused, not exceeding 60% of eligible patients (22). In another study of gynecology inpatients, thromboprophylaxis was shown to be decreasing between 2011 and 2017 for hysterectomy procedures (23).…”

Section: Discussionmentioning

confidence: 99%

Persistently High Rate of Venous Thromboembolic Disease in Inflammatory Bowel Disease: A Population-Based Study

2021

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INTRODUCTION: Venous thromboembolism (VTE) is known to be increased in inflammatory bowel disease (IBD). We aimed to determine whether rates of VTE in IBD have reduced over the past 30 years. METHODS: We used the population-based University of Manitoba IBD Epidemiology Database (1984–2018) to determine the incidence of VTE in IBD and the incidence rate ratio vs matched controls. In persons with IBD with and without VTE, we assessed for variables that were associated with an increased risk of VTE on multivariate logistic regression. RESULTS: The incidence of VTE in the IBD cohort was 7.6% which was significantly greater than in controls (3.3%, P < 0.0001). The overall age-standardized incidence rate of VTE was 433 per 100,000 in IBD and 184 per 100,000 in controls. The incidence of VTE was higher in Crohn's disease (8.4%) than in ulcerative colitis (6.9%, P = 0.0028). The incidence rate ratio in IBD vs controls was 2.36 (95% confidence interval 2.16–2.58). The increased risk was similar in males and females and in Crohn's disease compared with ulcerative colitis. The incidence rate among persons with IBD from 1985 to 2018 decreased very slowly, with annual percent change of −0.7% (P = 0.0003). Hospital admission, high comorbidity, use of antibodies to tumor necrosis factor for less than 3 years up until the time of the VTE, and the combination of steroid and antibodies to tumor necrosis factor increased the risk of VTE. DISCUSSION: Despite advancements in IBD management in the past 30 years, the rates of VTE have only been slowly decreasing and remain significantly increased compared with controls.

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Section: Discussionmentioning

confidence: 99%

Persistently High Rate of Venous Thromboembolic Disease in Inflammatory Bowel Disease: A Population-Based Study

2021

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“…Extended postoperative courses of enoxaparin upon hospital discharge have been shown to decrease VTE rates by 7% after RC [12,24]. However, VTE prophylaxis is generally underutilized after RC, with a recent study reporting a maximum of 58.6% of patients in the United States receiving in-hospital pharmacological thromboprophylaxis [25]. Additionally, although the authors found that the use of prophylaxis increased over the years of their study (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014), the risk of VTE did not change.…”

Section: Discussionmentioning

confidence: 99%

Outcomes from a prospectively implemented protocol using apixaban after robot‐assisted radical cystectomy

et al. 2023

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ObjectivesTo compare the safety and efficacy of oral apixaban with that of injectable enoxaparin after robot‐assisted radical cystectomy (RARC) for venous thromboembolism (VTE) thromboprophylaxis.Materials and MethodsWe conducted a retrospective review of prospectively collected data for all RARC patients treated at our tertiary care centre between 2018 and 2022. The study included two groups: patients who were subject to a prospectively implemented protocol from October 2021 to the present, comprising a 21‐day postoperative course of apixaban 2.5 mg twice daily after discharge, and patients treated prior to October 2021 who received enoxaparin 40 mg daily. Baseline demographics and clinical characteristics, such as VTE (defined as deep vein thrombosis and pulmonary embolism), were analysed. The primary outcome was incidence of symptomatic VTE confirmed with definitive imaging within 90 days of RARC. Secondary outcomes included major bleeding, complications, readmission, and mortality within 30 days postoperatively. Descriptive statistics included baseline patient characteristics, operative information and complications. Differences in baseline characteristics and postoperative data were compared between groups. Multivariate logistic regression was used to determine associations between variables and the primary outcome.ResultsA total of 124 patients received apixaban and 250 patients received enoxaparin prophylaxis. Ten patients (2.7%) experienced a VTE within 90 days postoperatively (two [1.6%] apixaban group vs eight [3.2%] enoxaparin group; P = 0.5). After patient stratification into European Association of Urology risk groups, no statistically significant difference in VTE rates was seen between groups in the apixaban (2.7% high‐ + intermediate‐risk group vs 1.1% low‐risk group; P = 0.5) and enoxaparin cohorts (4.3% high‐ + intermediate‐risk group vs 2.5% low‐risk group; P = 0.5). On multivariate logistic regression, no variables were associated with the development of the primary outcome.ConclusionProphylaxis with apixaban and enoxaparin showed no statistically significant differences in VTE rates among RARC patients. Apixaban appears to be safe and effective for VTE prophylaxis after RARC.

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“…Of note the survey was not designed to elucidate perioperative thromboprophylaxis patterns, where treatment gaps are also evident. 35 Likewise, Danish guidelines actually allow for use of primary thromboprophylaxis for selected ambulatory cancer patients, but this survey did not cover this aspect, which recent data suggest is rarely used. 36 …”

Section: Limitationsmentioning

confidence: 99%

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

Højen

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Nybo

et al. 2021

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Background Treatment patterns for cancer-associated venous thrombosis (CAT) has been shown to be nonconsistent with contemporary guideline recommendations, resulting in poor patient outcomes. Objectives The study aimed to describe contemporary CAT management in Danish oncology departments and identify knowledge gaps and inconsistencies between guidelines and clinical practice. Patients and Methods A survey questionnaire in Danish was developed based on contemporary national guidelines. Using an open recruitment strategy, invitations to participate in the electronic survey were sent to physicians employed at oncology departments in Denmark in winter of 2018/2019. The questionnaire was based on current national guidelines and included 10 items with multiple choices and a free-text option to specify or comment. The questionnaire was pilot-tested by a junior and senior oncologist. Results A total of 142 physicians completed the survey, representing all Danish geographical regions and various seniority. The majority reported that CAT was treated and followed up in oncology departments. However, 36.6% of the physicians were unaware of the existence of designated cancer thrombosis guidelines. Risk of venous thrombosis was generally assessed without diagnostic scores. Almost all (98.6%) reported low-molecular-weight heparin to be first-line treatment for CAT. Treatment duration seemed wrongly influenced by subtype of venous thrombosis, and 44.5% responded that thromboprophylaxis among hospitalized patients was substantially underused. Conclusion The variability in the daily clinical management of CAT demonstrated through this survey indicates a potential to increase awareness of available guidelines, standardized use of inpatient thromboprophylaxis, and organized treatment and follow-up in a multidisciplinary setting, which would potentially improve management of CAT in Denmark.

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Trends in Adherence to Thromboprophylaxis Guideline in Patients Undergoing Radical Cystectomy

Cited by 5 publications

References 27 publications

Persistently High Rate of Venous Thromboembolic Disease in Inflammatory Bowel Disease: A Population-Based Study

Persistently High Rate of Venous Thromboembolic Disease in Inflammatory Bowel Disease: A Population-Based Study

Outcomes from a prospectively implemented protocol using apixaban after robot‐assisted radical cystectomy

Management of Cancer-Associated Venous Thrombosis: A Nationwide Survey among Danish Oncologists

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