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Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease
Thrombosis and Haemostasis
Swansea University Authors:
Sarah Aldridge, Ashley Akbari
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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...
Published in: | Thrombosis and Haemostasis |
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ISSN: | 0340-6245 2567-689X |
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Georg Thieme Verlag KG
2025
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URI: | https://cronfa.swan.ac.uk/Record/cronfa68874 |
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2025-02-12T16:01:57Z |
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<?xml version="1.0"?><rfc1807><datestamp>2025-06-13T13:01:13.6885339</datestamp><bib-version>v2</bib-version><id>68874</id><entry>2025-02-12</entry><title>Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease</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>2025-02-12</date><deptcode>MEDS</deptcode><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-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.</abstract><type>Journal Article</type><journal>Thrombosis and Haemostasis</journal><volume>0</volume><journalNumber/><paginationStart/><paginationEnd/><publisher>Georg Thieme Verlag KG</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0340-6245</issnPrint><issnElectronic>2567-689X</issnElectronic><keywords>anticoagulants, deprescriptions, thromboembolism, hemorrhage, advance care planning</keywords><publishedDay>24</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-01-24</publishedDate><doi>10.1055/a-2524-5334</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>This study was supported by United Kingdom Research and Innovation, 10038000,10039823, European Union’s Horizon Europe research and innovation, 101057292</funders><projectreference/><lastEdited>2025-06-13T13:01:13.6885339</lastEdited><Created>2025-02-12T08:11:07.2051190</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>Eva</firstname><surname>Kempers</surname><orcid>0000-0001-9458-8674</orcid><order>1</order></author><author><firstname>Chantal</firstname><surname>Visser</surname><orcid>0000-0002-2025-1734</orcid><order>2</order></author><author><firstname>Eric</firstname><surname>Geijteman</surname><order>3</order></author><author><firstname>Jamilla</firstname><surname>Goedegebuur</surname><order>4</order></author><author><firstname>Johanneke</firstname><surname>Portielje</surname><order>5</order></author><author><firstname>Mette</firstname><surname>Søgaard</surname><order>6</order></author><author><firstname>Anne</firstname><surname>Ording</surname><order>7</order></author><author><firstname>Carline van den</firstname><surname>Dries</surname><order>8</order></author><author><firstname>Denise</firstname><surname>Abbel</surname><order>9</order></author><author><firstname>GJ</firstname><surname>Geersing</surname><order>10</order></author><author><firstname>Sarah</firstname><surname>Aldridge</surname><order>11</order></author><author><firstname>Kate</firstname><surname>Lifford</surname><order>12</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>13</order></author><author><firstname>Sjef van de</firstname><surname>Leur</surname><order>14</order></author><author><firstname>Melchior</firstname><surname>Nierman</surname><orcid>0000-0002-8647-7509</orcid><order>15</order></author><author><firstname>Isabelle</firstname><surname>Mahé</surname><orcid>0000-0003-1760-7880</orcid><order>16</order></author><author><firstname>Simon</firstname><surname>Mooijaart</surname><order>17</order></author><author><firstname>Sebastian</firstname><surname>Szmit</surname><order>18</order></author><author><firstname>Michelle</firstname><surname>Edwards</surname><order>19</order></author><author><firstname>Simon</firstname><surname>Noble</surname><order>20</order></author><author><firstname>Frederikus A.</firstname><surname>Klok</surname><orcid>0000-0001-9961-0754</orcid><order>21</order></author><author><firstname>Qingui</firstname><surname>Chen</surname><order>22</order></author><author><firstname>Suzanne C</firstname><surname>Cannegieter</surname><order>23</order></author><author><firstname>Marieke J.H.A.</firstname><surname>Kruip</surname><order>24</order></author></authors><documents><document><filename>68874__34022__834bab1118ba41a4a405cae674ab2076.pdf</filename><originalFilename>68874.VOR.pdf</originalFilename><uploaded>2025-04-11T15:41:52.8515452</uploaded><type>Output</type><contentLength>930854</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2025 The Author(s). 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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 |
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a42ee8ba1ff8174d5bb62d2d95364b90 aa1b025ec0243f708bb5eb0a93d6fb52 |
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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 |
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Journal article |
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Thrombosis and Haemostasis |
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publishDate |
2025 |
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Swansea University |
issn |
0340-6245 2567-689X |
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10.1055/a-2524-5334 |
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Georg Thieme Verlag KG |
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Faculty of Medicine, Health and Life Sciences |
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|
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facultyofmedicinehealthandlifesciences |
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Faculty of Medicine, Health and Life Sciences |
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facultyofmedicinehealthandlifesciences |
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Faculty of Medicine, Health and Life Sciences |
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Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science |
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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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11.380731 |