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Practice patterns for extended venous thromboembolism chemoprophylaxis among urologic oncologists after radical cystectomy.

MedStar author(s):

Carvalho, Filipe

Dall, Christopher P

Citation: Urologic Oncology. 38(11):849.e19-849.e23, 2020 11.PMID: 32616422Institution: MedStar Franklin Square Medical Center | MedStar Washington Hospital CenterDepartment: MedStar Georgetown University Hospital Residents | UrologyForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Anticoagulants/tu [Therapeutic Use] | *Cystectomy | *Enoxaparin/tu [Therapeutic Use] | *Postoperative Complications/pc [Prevention & Control] | *Practice Patterns, Physicians' | *Surgical Oncology | *Urinary Bladder Neoplasms/su [Surgery] | *Urology | *Venous Thromboembolism/pc [Prevention & Control] | Aftercare | Chemoprevention | Cystectomy/mt [Methods] | HumansYear: 2020 ISSN:

1078-1439

Name of journal: Urologic oncologyAbstract: CONCLUSIONS: The majority of surveyed urologic oncologists are prescribing subcutaneous enoxaparin ECP following RC. Poor patient adherence due to self-injections and financial barriers were frequently reported and represent a possible opportunity for the use of oral anticoagulants in the post- operative setting. These data will be used in the development of a proposed clinical trial of a DOAC in the post-RC setting. Copyright (c) 2020 Elsevier Inc. All rights reserved.INTRODUCTION: Extended outpatient chemoprophylaxis (ECP) following radical cystectomy (RC) for bladder cancer is proven to reduce rates of venous thromboembolism (VTE). While ECP is commonly performed with enoxaparin, its cost-effectiveness and adherence rate has been called into question. Data from orthopedic literature suggest that ECP with direct oral anticoagulants (DOACs) may be as effective in VTE prevention as enoxaparin in patients undergoing joint surgery. Our goal is to determine how urologic oncologists employ ECP following RC.METHODS: Members of the Society of Urologic Oncology were surveyed on practice patterns for the use of ECP after RC. Specific questions were asked regarding the use of inpatient and outpatient VTE prophylaxis, as well as perceived barriers to DOACs and enoxaparin.RESULTS: There were 121 of 878 (13.8%) respondents and the majority were in academic practices (83%). Most respondents had at least 5 years of experience and performed greater than 10 cystectomies annually. Almost all participants utilized inpatient (97%) and extended (80%) chemoprophylaxis for VTE prevention. Of those who elected for ECP, almost all (96%) used enoxaparin. Only 3 respondents (3%) prescribed oral agents such as rivaroxaban (2) or warfarin (1). Among those using enoxaparin, financial-specific barriers to treatment such as lack of insurance coverage (38%), inability to afford the medication (51%), and need for additional insurance authorization (44%) were reported. Poor patient adherence and refusal to perform injections were reported by 20% and 18% of respondents, respectively. Among the 23 physicians who did not use ECP, cost (39%) and delivery method (26%) were cited as barriers to treatment.All authors: Carvalho FL, Dall CP, Egan J, Galloway LAS, Krasnow R, Shaw N, Stamatakis LOriginally published: Urologic Oncology. 2020 Jun 29Fiscal year: FY2021Fiscal year of original publication: FY2020Digital Object Identifier:

https://dx.doi.org/10.1016/j.urolonc.2020.05.030

Date added to catalog: 2020-08-26

Holdings ( 1 )
Title notes ( 5 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	32616422	Available		32616422

CONCLUSIONS: The majority of surveyed urologic oncologists are prescribing subcutaneous enoxaparin ECP following RC. Poor patient adherence due to self-injections and financial barriers were frequently reported and represent a possible opportunity for the use of oral anticoagulants in the post- operative setting. These data will be used in the development of a proposed clinical trial of a DOAC in the post-RC setting. Copyright (c) 2020 Elsevier Inc. All rights reserved.

INTRODUCTION: Extended outpatient chemoprophylaxis (ECP) following radical cystectomy (RC) for bladder cancer is proven to reduce rates of venous thromboembolism (VTE). While ECP is commonly performed with enoxaparin, its cost-effectiveness and adherence rate has been called into question. Data from orthopedic literature suggest that ECP with direct oral anticoagulants (DOACs) may be as effective in VTE prevention as enoxaparin in patients undergoing joint surgery. Our goal is to determine how urologic oncologists employ ECP following RC.

METHODS: Members of the Society of Urologic Oncology were surveyed on practice patterns for the use of ECP after RC. Specific questions were asked regarding the use of inpatient and outpatient VTE prophylaxis, as well as perceived barriers to DOACs and enoxaparin.

RESULTS: There were 121 of 878 (13.8%) respondents and the majority were in academic practices (83%). Most respondents had at least 5 years of experience and performed greater than 10 cystectomies annually. Almost all participants utilized inpatient (97%) and extended (80%) chemoprophylaxis for VTE prevention. Of those who elected for ECP, almost all (96%) used enoxaparin. Only 3 respondents (3%) prescribed oral agents such as rivaroxaban (2) or warfarin (1). Among those using enoxaparin, financial-specific barriers to treatment such as lack of insurance coverage (38%), inability to afford the medication (51%), and need for additional insurance authorization (44%) were reported. Poor patient adherence and refusal to perform injections were reported by 20% and 18% of respondents, respectively. Among the 23 physicians who did not use ECP, cost (39%) and delivery method (26%) were cited as barriers to treatment.

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