Quality of vitamin K antagonist treatment during the last year of life

Visser, Chantal; Kempers, Eva K.; Goedgebuur, Jamilla; Abbel, Denise; Aldridge, Sarah; Edwards, Adrian; Edwards, Michelle; Geersing, Geert‐Jan; Ording, Anne Gulbech; C., Sjef J.; Lifford, Kate J.; Mahé, Isabelle; Mooijaart, Simon P.; Nierman, Melchior C.; A., Johanneke E.; Søgaard, Mette; Szmit, Sebastian; Wiersma, Nynke M.; R., Simon I.; Klok, Frederikus A.; Chen, Qingui; Cannegieter, Suzanne C.; T., Eric C.; H., Marieke J.; Consortium), (SERENITY

doi:10.1002/hem3.70135

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Quality of vitamin K antagonist treatment during the last year of life

Chantal Visser

, Eva K. Kempers

, Jamilla Goedgebuur, Denise Abbel, Sarah Aldridge, Adrian Edwards, Michelle Edwards, Geert‐Jan Geersing, Anne Gulbech Ording, Sjef J. C. M. van de Leur, Kate J. Lifford, Isabelle Mahé, Simon P. Mooijaart, Melchior C. Nierman, Johanneke E. A. Portielje, Mette Søgaard, Sebastian Szmit, Nynke M. Wiersma, Simon I. R. Noble, Frederikus A. Klok, Qingui Chen, Suzanne C. Cannegieter, Eric C. T. Geijteman, Marieke J. H. A. Kruip

, (SERENITY Consortium)

HemaSphere, Volume: 9, Issue: 5, Start page: e70135

Swansea University Author: Sarah Aldridge

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© 2025 The Author(s). HemaSphere published by John Wiley & Sons Ltd on behalf of European Hematology Association. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (CC BY-NC-ND).
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DOI (Published version): 10.1002/hem3.70135

Abstract

Limited data exist on the quality of anticoagulation in patients approaching the end of life. This study evaluated vitamin K antagonist (VKA) anticoagulation control during the last year of life, using nationwide data from Statistics Netherlands, linked to anticoagulation clinics' data and the...

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Published in:	HemaSphere
ISSN:	2572-9241 2572-9241
Published:	Wiley 2025
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa69542

first_indexed	2025-05-20T12:53:11Z
last_indexed	2025-06-06T07:03:28Z
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We included prevalent VKA users who were hospitalized with a severe medical condition and died between January 1, 2013, and December 31, 2019. Anticoagulation control was assessed using time in therapeutic range (TTR), time above therapeutic range (TAR), and time below therapeutic range (TBR) and the international normalized ratio (INR) variance growth rate (VGR), which reflects INR variability. Anticoagulation control was examined by two approaches: (1) over four intervals (0–12 months, 0–9 months, 0–6 months, and 0–3 months preceding death), and (2) in 3‐month intervals (9–12, 6–9, 3–6, and 0–3 months before death) to describe temporal changes. Among 6874 VKA users in their last year of life (median age 82 [Interquartile range: 76–87] years, 46.9% female), the most prevalent severe medical conditions were heart disease (60.4%), cancer (16.2%), and hip fracture (15.2%). As death approached, TTR and TBR decreased, while TAR and mean VGR increased, particularly in the last 3 months of life. This decline was more pronounced in cancer patients and acenocoumarol users. In conclusion, the quality of VKA anticoagulation declined in the last year of life in severely ill patients, marked by reduced TTR and increased TAR and VGR, suggesting an increased bleeding risk. 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spelling	2025-06-05T17:06:05.0611510 v2 69542 2025-05-20 Quality of vitamin K antagonist treatment during the last year of life a42ee8ba1ff8174d5bb62d2d95364b90 Sarah Aldridge Sarah Aldridge true false 2025-05-20 MEDS Limited data exist on the quality of anticoagulation in patients approaching the end of life. This study evaluated vitamin K antagonist (VKA) anticoagulation control during the last year of life, using nationwide data from Statistics Netherlands, linked to anticoagulation clinics' data and the Netherlands Cancer Registry. We included prevalent VKA users who were hospitalized with a severe medical condition and died between January 1, 2013, and December 31, 2019. Anticoagulation control was assessed using time in therapeutic range (TTR), time above therapeutic range (TAR), and time below therapeutic range (TBR) and the international normalized ratio (INR) variance growth rate (VGR), which reflects INR variability. Anticoagulation control was examined by two approaches: (1) over four intervals (0–12 months, 0–9 months, 0–6 months, and 0–3 months preceding death), and (2) in 3‐month intervals (9–12, 6–9, 3–6, and 0–3 months before death) to describe temporal changes. Among 6874 VKA users in their last year of life (median age 82 [Interquartile range: 76–87] years, 46.9% female), the most prevalent severe medical conditions were heart disease (60.4%), cancer (16.2%), and hip fracture (15.2%). As death approached, TTR and TBR decreased, while TAR and mean VGR increased, particularly in the last 3 months of life. This decline was more pronounced in cancer patients and acenocoumarol users. In conclusion, the quality of VKA anticoagulation declined in the last year of life in severely ill patients, marked by reduced TTR and increased TAR and VGR, suggesting an increased bleeding risk. These findings highlight the importance of reassessing VKA use and considering discontinuation in patients approaching the end of life. Journal Article HemaSphere 9 5 e70135 Wiley 2572-9241 2572-9241 19 5 2025 2025-05-19 10.1002/hem3.70135 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee This project has received funding from the European Union's Horizon Europe Research and Innovation Action under grant agreement no. 101057292. Additionally, UK Research and Innovation (UKRI) has provided funding under the UK government's Horizon Europe funding guarantee (grant agreement no. 10039823 for Cardiff University and 10038000 for Hull York Medical School). 2025-06-05T17:06:05.0611510 2025-05-20T13:45:46.4852707 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Chantal Visser 0000-0002-2025-1734 1 Eva K. Kempers 0000-0001-9458-8674 2 Jamilla Goedgebuur 3 Denise Abbel 4 Sarah Aldridge 5 Adrian Edwards 6 Michelle Edwards 7 Geert‐Jan Geersing 8 Anne Gulbech Ording 9 Sjef J. C. M. van de Leur 10 Kate J. Lifford 11 Isabelle Mahé 12 Simon P. Mooijaart 13 Melchior C. Nierman 14 Johanneke E. A. Portielje 15 Mette Søgaard 16 Sebastian Szmit 17 Nynke M. Wiersma 18 Simon I. R. Noble 19 Frederikus A. Klok 20 Qingui Chen 21 Suzanne C. Cannegieter 22 Eric C. T. Geijteman 23 Marieke J. H. A. Kruip 0000-0002-0265-4871 24 (SERENITY Consortium) 25 69542__34319__0c9d3f9fba814d0fadcef75ce4c83604.pdf hem3.70135.pdf 2025-05-20T13:45:46.3237170 Output 1785336 application/pdf Version of Record true © 2025 The Author(s). HemaSphere published by John Wiley & Sons Ltd on behalf of European Hematology Association. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (CC BY-NC-ND). true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title	Quality of vitamin K antagonist treatment during the last year of life
spellingShingle	Quality of vitamin K antagonist treatment during the last year of life Sarah Aldridge
title_short	Quality of vitamin K antagonist treatment during the last year of life
title_full	Quality of vitamin K antagonist treatment during the last year of life
title_fullStr	Quality of vitamin K antagonist treatment during the last year of life
title_full_unstemmed	Quality of vitamin K antagonist treatment during the last year of life
title_sort	Quality of vitamin K antagonist treatment during the last year of life
author_id_str_mv	a42ee8ba1ff8174d5bb62d2d95364b90
author_id_fullname_str_mv	a42ee8ba1ff8174d5bb62d2d95364b90_***_Sarah Aldridge
author	Sarah Aldridge
author2	Chantal Visser Eva K. Kempers Jamilla Goedgebuur Denise Abbel Sarah Aldridge Adrian Edwards Michelle Edwards Geert‐Jan Geersing Anne Gulbech Ording Sjef J. C. M. van de Leur Kate J. Lifford Isabelle Mahé Simon P. Mooijaart Melchior C. Nierman Johanneke E. A. Portielje Mette Søgaard Sebastian Szmit Nynke M. Wiersma Simon I. R. Noble Frederikus A. Klok Qingui Chen Suzanne C. Cannegieter Eric C. T. Geijteman Marieke J. H. A. Kruip (SERENITY Consortium)
format	Journal article
container_title	HemaSphere
container_volume	9
container_issue	5
container_start_page	e70135
publishDate	2025
institution	Swansea University
issn	2572-9241 2572-9241
doi_str_mv	10.1002/hem3.70135
publisher	Wiley
college_str	Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
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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
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description	Limited data exist on the quality of anticoagulation in patients approaching the end of life. This study evaluated vitamin K antagonist (VKA) anticoagulation control during the last year of life, using nationwide data from Statistics Netherlands, linked to anticoagulation clinics' data and the Netherlands Cancer Registry. We included prevalent VKA users who were hospitalized with a severe medical condition and died between January 1, 2013, and December 31, 2019. Anticoagulation control was assessed using time in therapeutic range (TTR), time above therapeutic range (TAR), and time below therapeutic range (TBR) and the international normalized ratio (INR) variance growth rate (VGR), which reflects INR variability. Anticoagulation control was examined by two approaches: (1) over four intervals (0–12 months, 0–9 months, 0–6 months, and 0–3 months preceding death), and (2) in 3‐month intervals (9–12, 6–9, 3–6, and 0–3 months before death) to describe temporal changes. Among 6874 VKA users in their last year of life (median age 82 [Interquartile range: 76–87] years, 46.9% female), the most prevalent severe medical conditions were heart disease (60.4%), cancer (16.2%), and hip fracture (15.2%). As death approached, TTR and TBR decreased, while TAR and mean VGR increased, particularly in the last 3 months of life. This decline was more pronounced in cancer patients and acenocoumarol users. In conclusion, the quality of VKA anticoagulation declined in the last year of life in severely ill patients, marked by reduced TTR and increased TAR and VGR, suggesting an increased bleeding risk. These findings highlight the importance of reassessing VKA use and considering discontinuation in patients approaching the end of life.
published_date	2025-05-19T05:30:22Z
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Quality of vitamin K antagonist treatment during the last year of life

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