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Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease

Eva Kempers Orcid Logo, Chantal Visser Orcid Logo, Eric Geijteman, Jamilla Goedegebuur, Johanneke Portielje, Mette Søgaard, Anne Ording, Carline van den Dries, Denise Abbel, GJ Geersing, Sarah Aldridge, Kate Lifford, Ashley Akbari Orcid Logo, Sjef van de Leur, Melchior Nierman Orcid Logo, Isabelle Mahé Orcid Logo, Simon Mooijaart, Sebastian Szmit, Michelle Edwards, Simon Noble, Frederikus A. Klok Orcid Logo, Qingui Chen, Suzanne C Cannegieter, Marieke J.H.A. Kruip

Thrombosis and Haemostasis

Swansea University Authors: Sarah Aldridge, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1055/a-2524-5334

Abstract

Background: Data on risks and benefits of long-term anticoagulants in patients with a life-limiting disease are limited. This cohort study aims to describe (dis)continuation of anticoagulants and incidences of bleeding and thromboembolic events in vitamin K antagonist (VKA) users with a life-limitin...

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Published in: Thrombosis and Haemostasis
ISSN: 0340-6245 2567-689X
Published: Georg Thieme Verlag KG 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68874
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This cohort study aims to describe (dis)continuation of anticoagulants and incidences of bleeding and thromboembolic events in vitamin K antagonist (VKA) users with a life-limiting disease. Methods: Data from five Dutch anticoagulation clinics were linked to data from Statistics Netherlands and the Netherlands Cancer registry. Prevalent VKA users diagnosed with a pre-specified life-limiting disease between 01/01/2013 and 31/12/2019 were included and followed until 31/12/2019. Hospitalization data were used to identify bleeding and thromboembolic events. Cumulative incidences of anticoagulant discontinuation were calculated, accounting for death as competing risk, and event rates were determined for both anticoagulant exposed and unexposed person-years (PYs). Results: Among 18,145 VKA users (median age 81 years, 49% females, median survival time 2.03 years), the most common life-limiting diseases were heart disease (60.0%), hip fracture (18.1%), and cancer (13.5%). One year after diagnosis, the cumulative incidence of anticoagulant discontinuation was 14.0% (95%CI: 13.5-14.6). Over 80% of patients continued anticoagulant therapy until the last month before death, with median 14 days between discontinuation and death. Event rates per 100 PYs (95%CI) were comparable during anticoagulant use and after discontinuation for bleeding 2.6 (2.4-2.8) versus 2.1 (1.5-2.8); venous thromboembolism 0.2 (0.1-0.2) versus 0.4 (0.2-0.7); and arterial thromboembolism 3.1 (2.9-3.3) versus 3.3 (2.6-4.2). 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spelling 2025-06-13T13:01:13.6885339 v2 68874 2025-02-12 Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease a42ee8ba1ff8174d5bb62d2d95364b90 Sarah Aldridge Sarah Aldridge true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2025-02-12 MEDS Background: Data on risks and benefits of long-term anticoagulants in patients with a life-limiting disease are limited. This cohort study aims to describe (dis)continuation of anticoagulants and incidences of bleeding and thromboembolic events in vitamin K antagonist (VKA) users with a life-limiting disease. Methods: Data from five Dutch anticoagulation clinics were linked to data from Statistics Netherlands and the Netherlands Cancer registry. Prevalent VKA users diagnosed with a pre-specified life-limiting disease between 01/01/2013 and 31/12/2019 were included and followed until 31/12/2019. Hospitalization data were used to identify bleeding and thromboembolic events. Cumulative incidences of anticoagulant discontinuation were calculated, accounting for death as competing risk, and event rates were determined for both anticoagulant exposed and unexposed person-years (PYs). Results: Among 18,145 VKA users (median age 81 years, 49% females, median survival time 2.03 years), the most common life-limiting diseases were heart disease (60.0%), hip fracture (18.1%), and cancer (13.5%). One year after diagnosis, the cumulative incidence of anticoagulant discontinuation was 14.0% (95%CI: 13.5-14.6). Over 80% of patients continued anticoagulant therapy until the last month before death, with median 14 days between discontinuation and death. Event rates per 100 PYs (95%CI) were comparable during anticoagulant use and after discontinuation for bleeding 2.6 (2.4-2.8) versus 2.1 (1.5-2.8); venous thromboembolism 0.2 (0.1-0.2) versus 0.4 (0.2-0.7); and arterial thromboembolism 3.1 (2.9-3.3) versus 3.3 (2.6-4.2). Conclusion: Most VKA users with a life-limiting disease continued anticoagulant treatment during their last phase of life, with similar rates of bleeding and thromboembolic events during use and after discontinuation. Journal Article Thrombosis and Haemostasis 0 Georg Thieme Verlag KG 0340-6245 2567-689X anticoagulants, deprescriptions, thromboembolism, hemorrhage, advance care planning 24 1 2025 2025-01-24 10.1055/a-2524-5334 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This study was supported by United Kingdom Research and Innovation, 10038000,10039823, European Union’s Horizon Europe research and innovation, 101057292 2025-06-13T13:01:13.6885339 2025-02-12T08:11:07.2051190 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Eva Kempers 0000-0001-9458-8674 1 Chantal Visser 0000-0002-2025-1734 2 Eric Geijteman 3 Jamilla Goedegebuur 4 Johanneke Portielje 5 Mette Søgaard 6 Anne Ording 7 Carline van den Dries 8 Denise Abbel 9 GJ Geersing 10 Sarah Aldridge 11 Kate Lifford 12 Ashley Akbari 0000-0003-0814-0801 13 Sjef van de Leur 14 Melchior Nierman 0000-0002-8647-7509 15 Isabelle Mahé 0000-0003-1760-7880 16 Simon Mooijaart 17 Sebastian Szmit 18 Michelle Edwards 19 Simon Noble 20 Frederikus A. Klok 0000-0001-9961-0754 21 Qingui Chen 22 Suzanne C Cannegieter 23 Marieke J.H.A. Kruip 24 68874__34022__834bab1118ba41a4a405cae674ab2076.pdf 68874.VOR.pdf 2025-04-11T15:41:52.8515452 Output 930854 application/pdf Version of Record true © 2025 The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License (CC BY). true eng https://creativecommons.org/licenses/by/4.0/
title Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
spellingShingle Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
Sarah Aldridge
Ashley Akbari
title_short Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
title_full Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
title_fullStr Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
title_full_unstemmed Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
title_sort Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
author_id_str_mv a42ee8ba1ff8174d5bb62d2d95364b90
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv a42ee8ba1ff8174d5bb62d2d95364b90_***_Sarah Aldridge
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Sarah Aldridge
Ashley Akbari
author2 Eva Kempers
Chantal Visser
Eric Geijteman
Jamilla Goedegebuur
Johanneke Portielje
Mette Søgaard
Anne Ording
Carline van den Dries
Denise Abbel
GJ Geersing
Sarah Aldridge
Kate Lifford
Ashley Akbari
Sjef van de Leur
Melchior Nierman
Isabelle Mahé
Simon Mooijaart
Sebastian Szmit
Michelle Edwards
Simon Noble
Frederikus A. Klok
Qingui Chen
Suzanne C Cannegieter
Marieke J.H.A. Kruip
format Journal article
container_title Thrombosis and Haemostasis
container_volume 0
publishDate 2025
institution Swansea University
issn 0340-6245
2567-689X
doi_str_mv 10.1055/a-2524-5334
publisher Georg Thieme Verlag KG
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
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description Background: Data on risks and benefits of long-term anticoagulants in patients with a life-limiting disease are limited. This cohort study aims to describe (dis)continuation of anticoagulants and incidences of bleeding and thromboembolic events in vitamin K antagonist (VKA) users with a life-limiting disease. Methods: Data from five Dutch anticoagulation clinics were linked to data from Statistics Netherlands and the Netherlands Cancer registry. Prevalent VKA users diagnosed with a pre-specified life-limiting disease between 01/01/2013 and 31/12/2019 were included and followed until 31/12/2019. Hospitalization data were used to identify bleeding and thromboembolic events. Cumulative incidences of anticoagulant discontinuation were calculated, accounting for death as competing risk, and event rates were determined for both anticoagulant exposed and unexposed person-years (PYs). Results: Among 18,145 VKA users (median age 81 years, 49% females, median survival time 2.03 years), the most common life-limiting diseases were heart disease (60.0%), hip fracture (18.1%), and cancer (13.5%). One year after diagnosis, the cumulative incidence of anticoagulant discontinuation was 14.0% (95%CI: 13.5-14.6). Over 80% of patients continued anticoagulant therapy until the last month before death, with median 14 days between discontinuation and death. Event rates per 100 PYs (95%CI) were comparable during anticoagulant use and after discontinuation for bleeding 2.6 (2.4-2.8) versus 2.1 (1.5-2.8); venous thromboembolism 0.2 (0.1-0.2) versus 0.4 (0.2-0.7); and arterial thromboembolism 3.1 (2.9-3.3) versus 3.3 (2.6-4.2). Conclusion: Most VKA users with a life-limiting disease continued anticoagulant treatment during their last phase of life, with similar rates of bleeding and thromboembolic events during use and after discontinuation.
published_date 2025-01-24T05:37:54Z
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