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Use of antithrombotic therapy and the risk of cardiovascular outcomes and bleeding in cancer patients at the end of life: A Danish nationwide cohort study
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Anette A Højen,
Frederikus A Klok,
Simon Noble,
Suzanne Cannegieter,
Anne Gulbech Ording
Journal of Thrombosis and Haemostasis, Volume: 23, Issue: 1, Pages: 190 - 200
Swansea University Authors:
Sarah Aldridge, Ashley Akbari
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DOI (Published version): 10.1016/j.jtha.2024.09.023
Abstract
Background: Despite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer. Objectives: To examine adherence and persistence with ATT in terminally ill cancer patients and investigate risks of major and clinically relevant blee...
| Published in: | Journal of Thrombosis and Haemostasis |
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| ISSN: | 1538-7933 1538-7836 |
| Published: |
Elsevier B.V.
2025
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| Online Access: |
Check full text
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa68063 |
| Abstract: |
Background: Despite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer. Objectives: To examine adherence and persistence with ATT in terminally ill cancer patients and investigate risks of major and clinically relevant bleeding, venous thromboembolism (VTE), and arterial thromboembolism (ATE) by ATT exposure. Methods: Using a Danish nationwide cohort of terminal cancer patients, ATT adherence in the year following terminal illness declaration was measured by the proportion of days covered (PDC) by prescription. Discontinuation was defined as a treatment gap of ≥30 days between prescription renewals. One-year cumulative incidences of bleeding complications, VTE, and ATE were calculated, considering the competing risk of death. Results: During 2013-2022, 86,732 terminally ill cancer patients were identified (median age 75 years, 47% female, median survival 57 days). At terminal illness declaration, 37.5% were receiving ATT (66.6% platelet inhibitors, 23.0% direct oral anticoagulants (DOAC), and 10.4% vitamin K antagonists (VKA)). The mean PDC was 88% (SD 30%), highest among platelet inhibitor users (mean PDC 89%) and lowest among VKA users (73%). One-year ATT discontinuation incidence was 7.9% (95% CI 7.7%-8.1%). Most patients continued ATT until death (74.8% platelet inhibitors, 58.8% DOACs, 61.6% VKAs). Patients receiving ATT had a lower one-year VTE risk but higher risks of ATE and major bleeding. Conclusion: Despite uncertain benefit-risk profile, most terminally ill cancer patients continue ATT until the end of life. These findings provide insights into current ATT utilisation and discontinuation dynamics in the challenging context of terminal illness. |
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| Keywords: |
anticoagulants; deprescription; neoplasms; palliative care; platelet aggregation inhibitors |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
The study is part of the research project SERENITY – “Towards Cancer Patient Empowerment for Optimal Use of Antithrombotic Therapy at the End of Life” (https://serenity-research.eu/). This project has received funding from the European Union’s Horizon Europe research and innovation action under grant agreement No 101057292. Additionally, United Kingdom Research and Innovation (UKRI) has provided funding under the United Kingdom government’s Horizon Europe funding guarantee [grant agreement No 10039823 for Cardiff University and 10038000 for Hull York Medical School]. Views and opinions expressed are, however, those of the authors only and do not necessarily reflect those of the European Union or The European Health and Digital Executive Agency. Neither the European Union nor the granting authority can be held responsible for them. |
| Issue: |
1 |
| Start Page: |
190 |
| End Page: |
200 |