International Survey of Thromboprophylaxis Practices During Neoadjuvant Therapy for Muscle-Invasive Bladder Cancer

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Background Patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) have increased risk for venous thromboembolism (VTE) and bleeding. Leading guidelines acknowledge these risks but provide only weak recommendations on pharmacologic thromboprophylaxis during NAC, potentially contributing to practice variation. We surveyed clinicians to characterize thromboprophylaxis use in this setting. Methods We conducted a cross-sectional survey of oncologists and urologists who frequently administer NAC for MIBC in the United Kingdom, Finland, Sweden, Denmark and Iceland. The survey, distributed by email, asked about clinician characteristics, use of pharmacologic thromboprophylaxis during NAC in MIBC patients, preferred agents, and reasons for withholding therapy. Results We received 46 responses from 67 invited clinicians (69%), including 44 oncologists and 2 urologists. Respondents had a median of 12 years in specialist practice and treated a median of 15 MIBC patients with NAC annually. More than half (57%) prescribed thromboprophylaxis to none, 15% to 1–9% of patients, 22% to 10–49% and 7% to more than 50%. The main reasons for withholding therapy were insufficient evidence of benefit (57%) and concerns about bleeding (28%). Conclusion Our sample of practicing clinicians prescribing NAC for MIBC patients reported limited and heterogeneous use of thromboprophylaxis during NAC in MIBC patients, largely driven by lack of evidence and perceived risk of bleeding. More trustworthy evidence and practice guidelines are much needed. Microabstract Patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) are at increased risk for thrombosis. However, guidelines on thromboprophylaxis are unclear. We surveyed clinicians who treat MIBC with NAC across the UK and Nordic countries. Most prescribed prophylaxis to few or none, citing limited evidence and bleeding concerns. These findings show a need for definitive trials.

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