Abstract
Objective
To examine the use of in-hospital pharmacologic thromboprophylaxis (PTP) in patients
undergoing radical cystectomy between 2004 and 2014 and to assess the risk of venous
thromboembolism (VTE) across the study period.
Material and Methods
We identified 8322 patients without contraindications to PTP undergoing radical cystectomy
in the US using the Premier Healthcare Database. Nonparametric Wilcoxon type test
for trend was employed to examine the trend of PTP utilization across the study period.
Ensuing, we employed multivariable logistic regression and generalized linear regression
models to examine the odds of receiving PTP and the risk of being diagnosed with VTE,
respectively.
Results
Based on VTE risk-stratification, the majority of patients (87.8%) qualified as “high-risk.”
Across the study period the use of PTP increased (Odds ratio 1.02, 95% confidence
interval (CI) 1.00-1.03, P = .044), but remained underutilized as the maximum percentage of patients receiving
in-hospital PTP did not exceed 58.6%. The risk of VTE did not vary across the study
period (risk ratio 0.97, 95%CI 0.92-1.02, P = .178).
Conclusion
Utilization of PTP increased throughout the study period, while the risk of VTE did
not change. Future studies are necessary to improve implementation of guideline-driven
care, as PTP remained underutilized throughout the study period.
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Article info
Publication history
Published online: October 03, 2019
Accepted:
September 25,
2019
Received:
July 10,
2019
Footnotes
Conflict of Interest: Quoc-Dien Trinh reports personal fees from Astellas, Bayer, Janssen, Insightec, and Intuitive Surgical. Adam S. Kibel reports consulting fees from Sanofi, Dendreon, Tokai, and Profound. Guru Sonpavde reports research support to institution from Astrazeneca, Bayer, Amgen, Boehringer-Ingelheim, Janssen, Merck, Sanofi, Pfizer.
Funding: Quoc-Dien Trinh is supported by the Genentech Bio-Oncology Career Development Award from the Conquer Cancer Foundation of the American Society of Clinical Oncology: ASCO Foundation does not list award numbers (Internal grant identifier: PS#114898), a Health Services Research pilot test grant from the Defense Health Agency, H00010-18-2-0018, Clay Hamlin Young Investigator Award from the Prostate Cancer Foundation: 16YOUN20. Guru Sonpavde is part of the advisory board for BMS, Exelixis, Bayer, Sanofi, Pfizer, Novartis, Eisai, Janssen, Amgen, Astrazeneca, Merck, Genentech, EMD Serono, Astellas/Agensys, as well a spart of the steering committee for Astrazeneca, BMS, Astellas, Debiopharm, Bavarian Nordic. Furthermore, he is Author for Uptodate and Speaker for Onclive, Research to Practice, and Physician Education Resource (PER).
Identification
Copyright
© 2019 Published by Elsevier Inc.
