Patients receiving neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) have increased risk for venous thromboembolism 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.
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.
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% to 9% of patients, 22% to 10% to 49%, and 7% to more than 50%. The main reasons for withholding therapy were insufficient evidence of benefit (57%) and concerns about bleeding (28%).
Our sample of practicing clinicians 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.
Clinical genitourinary cancer. 2026 Apr 17 [Epub ahead of print]
Alex L E Halme, Matias Posa, Jani Ruotsalainen, Sanna Hallamies, Andreas Carus, Sigurdur Gudjonsson, Heikki Junkkari, Riikka Järvinen, Niko K Nordlund, Sara Tornberg, Anders Ullén, Peter L Gross, Kirsi-Maija Kaukonen, James W F Catto, Syed A Hussain, Kari A O Tikkinen
Faculty of Medicine, University of Helsinki, Helsinki, Finland. Electronic address: ., Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland., Faculty of Medicine, University of Helsinki, Helsinki, Finland., Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Faculty of Medicine, Department of Urology, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland., Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland., Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Pelvic Cancer, Genitourinary Oncology and Urology Unit, Karolinska University Hospital, Stockholm, Sweden., Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada., The Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield, UK., Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. Electronic address: .