Understanding European patterns of deprescribing antithrombotic medication during end-of-life care in patients with cancer.

Autor: Martens ESL; Department of Medicine - Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Becker D; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany., Abele C; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany., Abbel D; Department of Medicine - Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Medicine - Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands., Achterberg WP; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands., Bax JJ; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands., Bertoletti L; Department of Vascular and Therapeutical Medicine, Jean Monnet University, University Hospital of Saint-Étienne, Saint-Étienne, France., Edwards ME; Department of Primary Care and Public Health, School of Medicine, Cardiff University, United Kingdom., Font C; Department of Medical Oncology, Hospital Clinic de Barcelona, Clinical Institute of Haematological and Oncological Diseases (ICMHO), Barcelona, Spain., Gava A; Societa per l'Assistenza al Malato Oncologico Terminale Onlus (S.A.M.O.T.) Ragusa Onlus, Ragusa, Italy., Goedegebuur J; Department of Medicine - Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands., Højen AA; Danish Center for Health Services Research, Aalborg University Hospital, Aalborg, Denmark., Huisman MV; Department of Medicine - Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands., Kruip MJHA; Department of Hematology, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands., Mahé I; Paris Cité University, Louis Mourier Hospital, Internal Medicine department, Inserm UMR_S1140 Innovative Therapies in Haemostasis, Paris, France., Mooijaart SP; Department of Medicine - Internal Medicine and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, the Netherlands., Pearson M; Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom., Seddon K; Division of Population Medicine, Cardiff University, Cardiff, United Kingdom., Szmit S; Department of Cardio-Oncology, Centre of Postgraduate Medical Education, Warsaw, Poland., Noble SIR; Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, United Kingdom., Klok FA; Department of Medicine - Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany., Konstantinides SV; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece. Electronic address: stavros.konstantinides@unimedizin-mainz.de.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2025 Jan; Vol. 245, pp. 109205. Date of Electronic Publication: 2024 Nov 09.
DOI: 10.1016/j.thromres.2024.109205
Abstrakt: Background: Even though antithrombotic therapy (ATT) probably has little or even negative effect on the well-being of patients with cancer near the end of life, it is often continued until death, possibly leading to excess bleeding complications, increased disease burden, reduced quality of life and higher healthcare costs.
Aim: To explore and describe European practice patterns and perspectives of healthcare professionals from different disciplines and specialties on ATT in the end-of-life care (EOLC) of patients with cancer.
Methods: We performed a two-week international cross-sectional survey study using flash-mob research methodology. Eligible were healthcare professionals from different institutions across Europe, who prescribed ATT and/or dealt with EOLC of patients with cancer. The survey comprised three parts, including a series of choice sets (hypothetical scenarios involving a set of characteristics changing in level [e.g., high vs. low thrombotic risk]) on ATT management in EOLC. The discrete choice experiment analysis was conducted using multinomial logistic regression.
Results: Out of 467 pre-registrants, 208 participated in the survey from 4 to 18 July 2023. The majority (53 %) considered a patient with cancer as in EOLC when life expectancy is below 3 months. Respondents reported seeing or treating 20 patients with cancer on ATT in EOLC per year (IQR 10-50). The median estimated frequency of considering ATT deprescription per healthcare professional was 10 times per year (IQR 4-10), while the frequency of actual deprescription was 5 times per year (IQR 2-10). Twenty percent of respondents had never deprescribed ATT in the context of EOLC. Across the eight choice sets, five respondents (2.7 %) found deprescribing inappropriate in any scenario. Deprescribing was more often considered in patients with poor ECOG-performance status, high bleeding risk and low-molecular-weight heparin use as opposed to oral ATT. Haemato-oncology and cardiovascular medicine specialists were more inclined to deprescribe antiplatelet therapy than other specialties.
Conclusion: Our study describes medical decision-making regarding ATT in EOLC of patients with cancer. Healthcare professionals' perspectives and practice patterns vary, and some preferences appear associated with the therapists' professional focus and region of practice.
Competing Interests: Declaration of competing interest LB reports personal fees from Merck Sharp & Dohme, LEO-Pharma, Bristol-Myers Squibb-Pfizer, and a grant for research from Merck Sharp & Dohme, outside the submitted work. AAH has received research grants from The Danish Heart Foundation and The Novo Nordisk Foundation, has received personal consulting fees from Bayer and has been on the speaker bureaus for Bayer, LEO-Pharma, and Bristol Myers Squibb, all of which are unrelated to this work. MJHAK reports grants from Sobi, The Netherlands Organisation for Health Research and Development, and the Dutch Thrombosis Association, and speaker fees from Roche, Sobi, and Bristol Myers Squibb, all grants and fees were unrelated to this work and paid to her institution. MP reports grants or contracts from the National Institute for Health Research to the Medical Research Council, Marie Curie to Yorkshire Cancer Research, National Health & Medical Research Council to the UKRI Arts & Humanities Research Council, and AstraZeneca to Research England, along with support for attending meetings and/or travel from the All-Ireland Institute of Hospice and Palliative Care. FAK reports grants or contracts from Bayer, Bristol Myers Squibb, British Society of Cardiovascular Imaging, Merck Sharp & Dohme, LEO-Pharma, Actelion, Varm-X, The Netherlands Organisation for Health Research and Development, the Dutch Thrombosis Association, the Dutch Heart Foundation, and the Horizon Europe Program, all unrelated to this work and paid to his institution. SVK reports research funding (grants) and consultation fees via his institution from Bayer AG, Boston Scientific, Inari Medical and Penumbra Inc.; and personal lecture & consultation honoraria/fees from Bayer AG, Boston Scientific, Daiichi-Sankyo and Penumbra Inc. All other authors declared no potential conflicts of interest with respect to the research.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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