Prevention of Venous Thromboembolism in Patients With Pancreatic Cancer: A Nationwide Survey

BACKGROUND: Pancreatic cancer is associated with a high risk of venous thromboembolism (VTE), with approximately one in five patients developing VTE. Randomized controlled trials have demonstrated that primary thromboprophylaxis is effective and safe in ambulatory patients with pancreatic cancer treated with chemotherapy. Despite international guideline recommendations, thromboprophylaxis appears underused in clinical practice. OBJECTIVES: To assess clinical practice regarding VTE prevention in ambulatory patients with pancreatic cancer among medical oncologists in the Netherlands. METHODS: A nationwide online survey was conducted between March and June 2025 among Dutch medical oncologists involved in pancreatic cancer care. The questionnaire assessed VTE risk perception, use of risk assessment tools, use of thromboprophylaxis, and patient education regarding thrombosis. RESULTS: Thirty-eight medical oncologists completed the survey. Most respondents (79%) classified the VTE risk in patients with pancreatic cancer as high or very high, yet 63% never prescribed thromboprophylaxis to ambulatory patients receiving chemotherapy. Lack of a national guideline recommendation was the most frequently reported reason for not prescribing thromboprophylaxis (74%). Only 11% of medical oncologists reported using the Khorana score, and only 3% always discussed VTE risk with patients. CONCLUSION: Although medical oncologists recognize the high risk of VTE in patients with pancreatic cancer, thromboprophylaxis remains substantially underused in clinical practice in the Netherlands. Limited awareness of risk assessment tools and national guidance were prominent findings that may inform future implementation efforts. These findings provide a benchmark for assessing the impact of the recently updated Dutch guideline on thromboprophylaxis in this high-risk population.