To assess the risk of venous thromboembolic events (VTEs) and bleeding with or without thromboprophylaxis during neoadjuvant chemotherapy in bladder cancer patients scheduled for radical cystectomy.
We conducted a retrospective cohort study in 4886 patients with non-metastatic bladder cancer undergoing cystectomy across 28 centres in 13 countries between 1990 and 2021. Inverse probability weighting analyses were performed to estimate the effect of thromboprophylaxis on VTE and bleeding.
In 147 patients (3%) VTEs were recorded within the first year. These occurred a median (interquartile range [IQR]) of 127 (82-198) days after bladder cancer diagnosis. Bleeding events occurred in 131 patients (3%) within the first year. These occurred a median (IQR) of 101 (83-171) days after cancer diagnosis. In inverse probability weighting analyses, compared to patients without thromboprophylaxis during chemotherapy, patients with thromboprophylaxis had not only a lower risk of VTE (hazard ratio [HR] 0.32, 95% confidence interval [CI] 0.12-0.81; P = 0.016) but also a lower bleeding risk (HR 0.03, 95% CI 0.09-0.12; P <0.0001). The retrospective nature of the study was its main limitation.
In this retrospective analysis, the benefit of thromboprophylaxis during neoadjuvant chemotherapy before cystectomy is in line with data from randomised trials in other malignancies. Our data suggest thromboprophylaxis is protective against VTEs and should be the standard of care during neoadjuvant chemotherapy.
BJU international. 2024 Jul 03 [Epub ahead of print]
Luca Antonelli, Pedro David Wendel-Garcia, Manja Deforth, Luca Afferi, Costantino Leonardo, Francesco Esperto, Marco Borghesi, Alessandro Antonelli, Karl Tully, Paolo Umari, Simone Albisinni, Andrea Mari, Renate Pichler, Francesco Claps, Jeremy Yuen-Chun Teoh, Mathieu Roumiguié, Gerald Bastian Schulz, Luca Orecchia, Francesco Soria, Morgan Roupret, Gautier Marcq, Cedric Poyet, Majed Alrumayyan, Michael Rink, Stefania Zamboni, Maria Riaza Montes, Steven Okoye, Riccardo Campi, Wojciech Krajewski, Laura Mertens, Meftun Culpan, Luke T Lavallée, Marco Moschini, Ulrike Held, Christian Daniel Fankhauser, EAU YAU urothelial carcinoma working group
Department of Urology, Luzerner Kantonsspital, University of Lucerne, Lucerne, Switzerland., Department of Biostatistics at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland., Department of Urology, Sapienza University of Rome, Rome, Italy., Department of Urology, Campus Bio-Medico University, Rome, Italy., IRCCS Ospedale Policlinico S. Martino, Genoa, Italy., Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy., Departement of Urology and Neurourology, Marien Hospital Herne, Ruhr University Bochum, Bochum, Germany., St. George's University Hospital, London, UK., Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy., Unit of Oncologic Minimally-Invasive Urology and Andrology - Careggi Hospital, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy., Department of Urology, Medical University of Innsbruck, Innsbruck, Austria., Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy., Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China., Department of Urology, CHU-IUCT Toulouse, Toulouse, France., Department of Urology, LMU Munich, Munich, Germany., Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy., Division of Urology, Department of Surgical Sciences, Torino School of Medicine, AOU città della Salute e della Scienza di Torino, Torino, Italy., GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France., Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France., Department of Urology, University Hospital Zürich, Zürich, Switzerland., Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada., Department of Urology, Marienkrankenhaus Hamburg, Hamburg, Germany., Unit of Urology, Department of Medical and Surgical Specialities, Radiological Science and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy., Galdakao-Usansolo Hospital, Vizcaya, Spain., Department of Urology, Charité-Universitätsmedizin Berlin, Berlin, Germany., Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy., Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, Wrocław, Poland., Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands., Department of Urology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey., Division of Urology, Department of Surgery, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada., Department of Urology and Division of Experimental Oncology, Urological Research Institute, Vita-Salute San Raffaele, Milan, Italy.