No Cover Image

Journal article 132 views 26 downloads

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

Mette Søgaard, Marie Ørskov, Martin Jensen, Jamilla Goedegebuur, Eva K Kempers, Chantal Visser, Eric C T Geijteman, Denise Abbel, Simon P Mooijaart, Geert-Jan Geersing, Johanneke Portielje, Adrian Edwards, Sarah Aldridge, Ashley Akbari Orcid Logo, 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 Orcid Logo

  • 68063.VOR.pdf

    PDF | Version of Record

    © 2024 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license.

    Download (707.7KB)

Check full text

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...

Full description

Published in: Journal of Thrombosis and Haemostasis
ISSN: 1538-7933 1538-7836
Published: Elsevier B.V. 2025
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa68063
first_indexed 2024-10-25T08:42:01Z
last_indexed 2025-01-30T14:29:34Z
id cronfa68063
recordtype SURis
fullrecord <?xml version="1.0"?><rfc1807><datestamp>2025-01-30T11:27:56.0922720</datestamp><bib-version>v2</bib-version><id>68063</id><entry>2024-10-25</entry><title>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</title><swanseaauthors><author><sid>a42ee8ba1ff8174d5bb62d2d95364b90</sid><firstname>Sarah</firstname><surname>Aldridge</surname><name>Sarah Aldridge</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2024-10-25</date><deptcode>MEDS</deptcode><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 &#x2265;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.</abstract><type>Journal Article</type><journal>Journal of Thrombosis and Haemostasis</journal><volume>23</volume><journalNumber>1</journalNumber><paginationStart>190</paginationStart><paginationEnd>200</paginationEnd><publisher>Elsevier B.V.</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1538-7933</issnPrint><issnElectronic>1538-7836</issnElectronic><keywords>anticoagulants; deprescription; neoplasms; palliative care; platelet aggregation inhibitors</keywords><publishedDay>1</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-01-01</publishedDate><doi>10.1016/j.jtha.2024.09.023</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>The study is part of the research project SERENITY &#x2013; &#x201C;Towards Cancer Patient Empowerment for Optimal Use of Antithrombotic Therapy at the End of Life&#x201D; (https://serenity-research.eu/). This project has received funding from the European Union&#x2019;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&#x2019;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.</funders><projectreference/><lastEdited>2025-01-30T11:27:56.0922720</lastEdited><Created>2024-10-25T09:26:52.0959722</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Mette</firstname><surname>S&#xF8;gaard</surname><order>1</order></author><author><firstname>Marie</firstname><surname>&#xD8;rskov</surname><order>2</order></author><author><firstname>Martin</firstname><surname>Jensen</surname><order>3</order></author><author><firstname>Jamilla</firstname><surname>Goedegebuur</surname><order>4</order></author><author><firstname>Eva K</firstname><surname>Kempers</surname><order>5</order></author><author><firstname>Chantal</firstname><surname>Visser</surname><order>6</order></author><author><firstname>Eric C T</firstname><surname>Geijteman</surname><order>7</order></author><author><firstname>Denise</firstname><surname>Abbel</surname><order>8</order></author><author><firstname>Simon P</firstname><surname>Mooijaart</surname><order>9</order></author><author><firstname>Geert-Jan</firstname><surname>Geersing</surname><order>10</order></author><author><firstname>Johanneke</firstname><surname>Portielje</surname><order>11</order></author><author><firstname>Adrian</firstname><surname>Edwards</surname><order>12</order></author><author><firstname>Sarah</firstname><surname>Aldridge</surname><order>13</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>14</order></author><author><firstname>Anette A</firstname><surname>H&#xF8;jen</surname><order>15</order></author><author><firstname>Frederikus A</firstname><surname>Klok</surname><order>16</order></author><author><firstname>Simon</firstname><surname>Noble</surname><order>17</order></author><author><firstname>Suzanne</firstname><surname>Cannegieter</surname><order>18</order></author><author><firstname>Anne Gulbech</firstname><surname>Ording</surname><order>19</order></author></authors><documents><document><filename>68063__33437__497ea753b5dc4bb494c463cb9b2379ca.pdf</filename><originalFilename>68063.VOR.pdf</originalFilename><uploaded>2025-01-30T11:23:18.2177288</uploaded><type>Output</type><contentLength>724687</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; 2024 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-01-30T11:27:56.0922720 v2 68063 2024-10-25 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 a42ee8ba1ff8174d5bb62d2d95364b90 Sarah Aldridge Sarah Aldridge true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2024-10-25 MEDS 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. Journal Article Journal of Thrombosis and Haemostasis 23 1 190 200 Elsevier B.V. 1538-7933 1538-7836 anticoagulants; deprescription; neoplasms; palliative care; platelet aggregation inhibitors 1 1 2025 2025-01-01 10.1016/j.jtha.2024.09.023 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 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. 2025-01-30T11:27:56.0922720 2024-10-25T09:26:52.0959722 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Mette Søgaard 1 Marie Ørskov 2 Martin Jensen 3 Jamilla Goedegebuur 4 Eva K Kempers 5 Chantal Visser 6 Eric C T Geijteman 7 Denise Abbel 8 Simon P Mooijaart 9 Geert-Jan Geersing 10 Johanneke Portielje 11 Adrian Edwards 12 Sarah Aldridge 13 Ashley Akbari 0000-0003-0814-0801 14 Anette A Højen 15 Frederikus A Klok 16 Simon Noble 17 Suzanne Cannegieter 18 Anne Gulbech Ording 19 68063__33437__497ea753b5dc4bb494c463cb9b2379ca.pdf 68063.VOR.pdf 2025-01-30T11:23:18.2177288 Output 724687 application/pdf Version of Record true © 2024 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license. true eng http://creativecommons.org/licenses/by/4.0/
title 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
spellingShingle 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
Sarah Aldridge
Ashley Akbari
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
author_id_str_mv a42ee8ba1ff8174d5bb62d2d95364b90
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv a42ee8ba1ff8174d5bb62d2d95364b90_***_Sarah Aldridge
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Sarah Aldridge
Ashley Akbari
author2 Mette Søgaard
Marie Ørskov
Martin Jensen
Jamilla Goedegebuur
Eva K Kempers
Chantal Visser
Eric C T Geijteman
Denise Abbel
Simon P Mooijaart
Geert-Jan Geersing
Johanneke Portielje
Adrian Edwards
Sarah Aldridge
Ashley Akbari
Anette A Højen
Frederikus A Klok
Simon Noble
Suzanne Cannegieter
Anne Gulbech Ording
format Journal article
container_title Journal of Thrombosis and Haemostasis
container_volume 23
container_issue 1
container_start_page 190
publishDate 2025
institution Swansea University
issn 1538-7933
1538-7836
doi_str_mv 10.1016/j.jtha.2024.09.023
publisher Elsevier B.V.
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description 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.
published_date 2025-01-01T08:17:05Z
_version_ 1829270848409698304
score 11.0578165

Similar Items