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.

Autor:	Søgaard M; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Gistrup, Denmark. Electronic address: mette.soegaard@rn.dk., Ørskov M; Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Department of Ophthalmology, Aalborg University Hospital, Gistrup, Denmark., Jensen M; Unit for Clinical Biostatistics, Aalborg University Hospital, Gistrup, Denmark., Goedegebuur J; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands., Kempers EK; Department of Hematology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands., Visser C; Department of Hematology, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands., Geijteman ECT; Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands., Abbel D; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands., Mooijaart SP; Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands., Geersing GJ; Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Portielje J; Department of Medical Oncology, Erasmus Medical Center, Rotterdam, the Netherlands., Edwards A; Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom., Aldridge SJ; Population Data Science, Swansea University, Swansea, United Kingdom., Akbari A; Population Data Science, Swansea University, Swansea, United Kingdom., Højen AA; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Gistrup, Denmark., Klok FA; Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Noble S; Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom., Cannegieter S; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands., Ording AG; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Gistrup, Denmark.
Jazyk:	angličtina
Zdroj:	Journal of thrombosis and haemostasis : JTH [J Thromb Haemost] 2024 Oct 10. Date of Electronic Publication: 2024 Oct 10.
DOI:	10.1016/j.jtha.2024.09.023
Abstrakt:	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, and 10.4% vitamin K antagonists [VKAs]). The mean PDC with ATT 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% direct oral anticoagulants, and 61.6% VKAs). Patients receiving ATT had a lower 1-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 utilization and discontinuation dynamics in the challenging context of terminal illness. Competing Interests: Declaration of competing interests There are no competing interests to disclose. (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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