Gaps Between Guidelines and Practice in VTE Prevention for Advanced NSCLC Outpatients: A Nationwide Cross-Sectional...

Background: Venous thromboembolism (VTE) is a common and serious complication in patients with advanced non-small-cell lung cancer (NSCLC). While guidelines recommend prophylactic anticoagulation for cancer outpatients at high risk, its clinical implementation remains conservative in China. Objectives: This study aimed to investigate the current use of prophylactic anticoagulation for advanced NSCLC outpatients at high risk of VTE in China and explore factors influencing physicians' decision-making. Methods: A descriptive cross-sectional survey using a convenience sampling approach was conducted from May to June 2025 among physicians from multiple top-tier tertiary hospitals across China. The survey assessed physicians' knowledge, practices, and concerns regarding VTE risk assessment and prophylactic anticoagulation. Descriptive statistics and multiple response analyses were performed using SPSS 25.0. Results: A total of 235 valid responses were collected. Although 84.7% of physicians reported receiving anticoagulation training, only 57.8% routinely used the Khorana score for risk assessment. After excluding six physicians (2.7%) who reported never assessing VTE risk, 59.4% reported initiating prophylactic anticoagulation for patients with a Khorana score ≥ 2. Direct oral anticoagulants were preferred by 75.6% of physicians. Key concerns included management of bleeding events (78.6%) and adverse reactions monitoring (61.1%). Notably, only 49.4% of physicians reported being familiar with the Khorana score. Conclusions: Prophylactic anticoagulation for advanced NSCLC outpatients appears to remain underutilized in China. Limited familiarity with VTE risk assessment tools and concerns regarding bleeding risk may influence physicians' clinical decisions. Educational initiatives and prospective studies may help improve guideline adherence.