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Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data

Sarah Aldridge, Ashley Akbari Orcid Logo, Adrian Edwards Orcid Logo, Kate J. Lifford Orcid Logo, Denise Abbel Orcid Logo, Suzanne Cannegieter Orcid Logo, Jamilla Goedegebuur Orcid Logo, Eva K. Kempers Orcid Logo, Mette Søgaard Orcid Logo, Chantal Visser Orcid Logo, Geert‐Jan Geersing Orcid Logo, Marieke J. H. Kruip Orcid Logo, Anne Gulbech Ording Orcid Logo, Carline van den Dries Orcid Logo, Eric C. T. Geijteman Orcid Logo, Erik Klok Orcid Logo, Isabelle Mahé Orcid Logo, Simon P. Mooijaart Orcid Logo, Sebastian Szmit Orcid Logo, Simon Noble Orcid Logo

British Journal of Haematology

Swansea University Authors: Sarah Aldridge, Ashley Akbari Orcid Logo

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DOI (Published version): 10.1111/bjh.70032

Abstract

Anti-thrombotic therapy (ATT) in cancer patients approaching the end of life presents significant clinical challenges, balancing thrombotic and bleeding risks. This study analysed ATT prescribing patterns and associated outcomes in patients diagnosed with poor prognosis cancer, defined as cancer dia...

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Published in: British Journal of Haematology
ISSN: 0007-1048 1365-2141
Published: Wiley 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69965
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This study analysed ATT prescribing patterns and associated outcomes in patients diagnosed with poor prognosis cancer, defined as cancer diagnoses associated with a 1-year life expectancy, using the Welsh national Secure Anonymised Information Linkage Databank. Retrospective cohort study of adults in Wales diagnosed with poor prognosis cancer between 2013 and 2021, following up patients from cancer diagnosis until death, end of follow-up or study end (31 December 2021). Outcomes included ATT discontinuation, bleeding and thromboembolic events in secondary care. We identified a cohort of 25&#x2009;783 adults with a median survival of 145&#x2009;days. Of these, 32% were receiving ATT at diagnosis, with 77% continuing until death. One-year cumulative incidence of ATT discontinuation was 19% (95% CI: 18%&#x2013;20%). The 1-year cumulative incidence of bleeding was 3.2% (95% CI: 3.0%&#x2013;3.4%) and of thromboembolic events was 5.3% (95% CI: 5.0%&#x2013;5.6%). 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spelling 2025-09-04T09:45:57.0409197 v2 69965 2025-07-15 Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data a42ee8ba1ff8174d5bb62d2d95364b90 Sarah Aldridge Sarah Aldridge true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2025-07-15 MEDS Anti-thrombotic therapy (ATT) in cancer patients approaching the end of life presents significant clinical challenges, balancing thrombotic and bleeding risks. This study analysed ATT prescribing patterns and associated outcomes in patients diagnosed with poor prognosis cancer, defined as cancer diagnoses associated with a 1-year life expectancy, using the Welsh national Secure Anonymised Information Linkage Databank. Retrospective cohort study of adults in Wales diagnosed with poor prognosis cancer between 2013 and 2021, following up patients from cancer diagnosis until death, end of follow-up or study end (31 December 2021). Outcomes included ATT discontinuation, bleeding and thromboembolic events in secondary care. We identified a cohort of 25 783 adults with a median survival of 145 days. Of these, 32% were receiving ATT at diagnosis, with 77% continuing until death. One-year cumulative incidence of ATT discontinuation was 19% (95% CI: 18%–20%). The 1-year cumulative incidence of bleeding was 3.2% (95% CI: 3.0%–3.4%) and of thromboembolic events was 5.3% (95% CI: 5.0%–5.6%). ATT was prevalent at cancer diagnosis and discontinuation before death was uncommon. The management of ATT is complex in patients with advanced cancer and there is a need for clearer guidance on appropriate discontinuation strategies as well as when to continue these medicines. Journal Article British Journal of Haematology 0 Wiley 0007-1048 1365-2141 anti-coagulants; anti-platelets; anti-thrombotic therapy; cohort study; end of life cancer care; palliative care 1 9 2025 2025-09-01 10.1111/bjh.70032 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) UK Research and Innovation (Grant Numbers: 10039823, 10038000); HORIZON EUROPE European Innovation Council (Grant Number: 101057292) 2025-09-04T09:45:57.0409197 2025-07-15T10:52:37.3038834 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Sarah Aldridge 1 Ashley Akbari 0000-0003-0814-0801 2 Adrian Edwards 0000-0002-6228-4446 3 Kate J. Lifford 0000-0002-9782-2080 4 Denise Abbel 0000-0002-7111-6604 5 Suzanne Cannegieter 0000-0003-4707-2303 6 Jamilla Goedegebuur 0000-0001-9571-7431 7 Eva K. Kempers 0000-0001-9458-8674 8 Mette Søgaard 0000-0002-2830-4968 9 Chantal Visser 0000-0002-2025-1734 10 Geert‐Jan Geersing 0000-0001-6976-9844 11 Marieke J. H. Kruip 0000-0002-0265-4871 12 Anne Gulbech Ording 0000-0002-8073-7664 13 Carline van den Dries 0000-0001-7602-3522 14 Eric C. T. Geijteman 0000-0001-7354-2220 15 Erik Klok 0000-0001-9961-0754 16 Isabelle Mahé 0000-0003-1760-7880 17 Simon P. Mooijaart 0000-0003-3106-3568 18 Sebastian Szmit 0000-0002-3075-1943 19 Simon Noble 0000-0001-5425-2383 20 69965__35025__42e7f005f57d4de8af2cd925573039e1.pdf 69965.VoR.pdf 2025-09-04T09:42:00.9078967 Output 1215878 application/pdf Version of Record true © 2025 The Author(s). This is an open access article under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/
title Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data
spellingShingle Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data
Sarah Aldridge
Ashley Akbari
title_short Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data
title_full Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data
title_fullStr Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data
title_full_unstemmed Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data
title_sort Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data
author_id_str_mv a42ee8ba1ff8174d5bb62d2d95364b90
aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv a42ee8ba1ff8174d5bb62d2d95364b90_***_Sarah Aldridge
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
author Sarah Aldridge
Ashley Akbari
author2 Sarah Aldridge
Ashley Akbari
Adrian Edwards
Kate J. Lifford
Denise Abbel
Suzanne Cannegieter
Jamilla Goedegebuur
Eva K. Kempers
Mette Søgaard
Chantal Visser
Geert‐Jan Geersing
Marieke J. H. Kruip
Anne Gulbech Ording
Carline van den Dries
Eric C. T. Geijteman
Erik Klok
Isabelle Mahé
Simon P. Mooijaart
Sebastian Szmit
Simon Noble
format Journal article
container_title British Journal of Haematology
container_volume 0
publishDate 2025
institution Swansea University
issn 0007-1048
1365-2141
doi_str_mv 10.1111/bjh.70032
publisher Wiley
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 Anti-thrombotic therapy (ATT) in cancer patients approaching the end of life presents significant clinical challenges, balancing thrombotic and bleeding risks. This study analysed ATT prescribing patterns and associated outcomes in patients diagnosed with poor prognosis cancer, defined as cancer diagnoses associated with a 1-year life expectancy, using the Welsh national Secure Anonymised Information Linkage Databank. Retrospective cohort study of adults in Wales diagnosed with poor prognosis cancer between 2013 and 2021, following up patients from cancer diagnosis until death, end of follow-up or study end (31 December 2021). Outcomes included ATT discontinuation, bleeding and thromboembolic events in secondary care. We identified a cohort of 25 783 adults with a median survival of 145 days. Of these, 32% were receiving ATT at diagnosis, with 77% continuing until death. One-year cumulative incidence of ATT discontinuation was 19% (95% CI: 18%–20%). The 1-year cumulative incidence of bleeding was 3.2% (95% CI: 3.0%–3.4%) and of thromboembolic events was 5.3% (95% CI: 5.0%–5.6%). ATT was prevalent at cancer diagnosis and discontinuation before death was uncommon. The management of ATT is complex in patients with advanced cancer and there is a need for clearer guidance on appropriate discontinuation strategies as well as when to continue these medicines.
published_date 2025-09-01T05:29:35Z
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score 11.089386

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