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.

Søgaard, Mette; Ørskov, Marie; Jensen, Martin; Goedegebuur, Jamilla; Kempers, Eva K; Visser, Chantal; T, Eric C; Abbel, Denise; Mooijaart, Simon P; Geersing, Geert-Jan; Portielje, Johanneke; Edwards, Adrian; Aldridge, Sarah; Akbari, Ashley; Højen, Anette A; Klok, Frederikus A; Noble, Simon; Cannegieter, Suzanne; Ording, Anne Gulbech

doi:10.1016/j.jtha.2024.09.023

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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.

Mette Søgaard, Marie Ørskov, Martin Jensen, Jamilla Goedegebuur, Eva K Kempers, Chantal Visser, Eric C T Geijteman, Denise Abbel, Simon P Mooijaart, Geert-Jan Geersing, Johanneke Portielje, Adrian Edwards, Sarah Aldridge, Ashley Akbari

, Anette A Højen, Frederikus A Klok, Simon Noble, Suzanne Cannegieter, Anne Gulbech Ording

Journal of Thrombosis and Haemostasis

Swansea University Authors: Sarah Aldridge, Ashley Akbari

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DOI (Published version): 10.1016/j.jtha.2024.09.023

Abstract

Despite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer. To examine adherence and persistence with ATT in terminally ill cancer patients and investigate risks of major and clinically relevant bleeding, venous thromboembo...

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Published in:	Journal of Thrombosis and Haemostasis
ISSN:	1538-7933 1538-7836
Published:	Elsevier B.V. 2024
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa68063
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first_indexed	2024-10-25T08:42:01Z
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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. 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. 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 (DOAC), and 10.4% vitamin K antagonists (VKA)). The mean PDC 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% DOACs, 61.6% VKAs). Patients receiving ATT had a lower one-year VTE risk but higher risks of ATE and major bleeding. Despite uncertain benefit-risk profile, most terminally ill cancer patients continue ATT until the end of life. These findings provide insights into current ATT utilisation and discontinuation dynamics in the challenging context of terminal illness. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.]</abstract><type>Journal Article</type><journal>Journal of Thrombosis and Haemostasis</journal><volume/><journalNumber/><paginationStart/><paginationEnd/><publisher>Elsevier B.V.</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>1538-7933</issnPrint><issnElectronic>1538-7836</issnElectronic><keywords>Cancer, palliative care, platelet inhibitor, anticoagulation, deprescribing</keywords><publishedDay>10</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-10-10</publishedDate><doi>10.1016/j.jtha.2024.09.023</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>The study is part of the research project SERENITY – “Towards Cancer Patient Empowerment for Optimal Use of Antithrombotic Therapy at the End of Life” (https://serenity-research.eu/). This project has received funding from the European Union’s Horizon Europe research and innovation action under grant agreement No 101057292. Additionally, United Kingdom Research and Innovation (UKRI) has provided funding under the United Kingdom government’s Horizon Europe funding guarantee [grant agreement No 10039823 for Cardiff University and 10038000 for Hull York Medical School].</funders><projectreference/><lastEdited>2024-10-25T12:17:02.8523190</lastEdited><Created>2024-10-25T09:26:52.0959722</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>Mette</firstname><surname>Søgaard</surname><order>1</order></author><author><firstname>Marie</firstname><surname>Ørskov</surname><order>2</order></author><author><firstname>Martin</firstname><surname>Jensen</surname><order>3</order></author><author><firstname>Jamilla</firstname><surname>Goedegebuur</surname><order>4</order></author><author><firstname>Eva K</firstname><surname>Kempers</surname><order>5</order></author><author><firstname>Chantal</firstname><surname>Visser</surname><order>6</order></author><author><firstname>Eric C T</firstname><surname>Geijteman</surname><order>7</order></author><author><firstname>Denise</firstname><surname>Abbel</surname><order>8</order></author><author><firstname>Simon P</firstname><surname>Mooijaart</surname><order>9</order></author><author><firstname>Geert-Jan</firstname><surname>Geersing</surname><order>10</order></author><author><firstname>Johanneke</firstname><surname>Portielje</surname><order>11</order></author><author><firstname>Adrian</firstname><surname>Edwards</surname><order>12</order></author><author><firstname>Sarah</firstname><surname>Aldridge</surname><order>13</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>14</order></author><author><firstname>Anette A</firstname><surname>Højen</surname><order>15</order></author><author><firstname>Frederikus A</firstname><surname>Klok</surname><order>16</order></author><author><firstname>Simon</firstname><surname>Noble</surname><order>17</order></author><author><firstname>Suzanne</firstname><surname>Cannegieter</surname><order>18</order></author><author><firstname>Anne Gulbech</firstname><surname>Ording</surname><order>19</order></author></authors><documents/><OutputDurs/></rfc1807>
spelling	v2 68063 2024-10-25 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. a42ee8ba1ff8174d5bb62d2d95364b90 Sarah Aldridge Sarah Aldridge true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 2024-10-25 MEDS Despite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer. 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. 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. 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 (DOAC), and 10.4% vitamin K antagonists (VKA)). The mean PDC 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% DOACs, 61.6% VKAs). Patients receiving ATT had a lower one-year VTE risk but higher risks of ATE and major bleeding. Despite uncertain benefit-risk profile, most terminally ill cancer patients continue ATT until the end of life. These findings provide insights into current ATT utilisation and discontinuation dynamics in the challenging context of terminal illness. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.] Journal Article Journal of Thrombosis and Haemostasis Elsevier B.V. 1538-7933 1538-7836 Cancer, palliative care, platelet inhibitor, anticoagulation, deprescribing 10 10 2024 2024-10-10 10.1016/j.jtha.2024.09.023 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee The study is part of the research project SERENITY – “Towards Cancer Patient Empowerment for Optimal Use of Antithrombotic Therapy at the End of Life” (https://serenity-research.eu/). This project has received funding from the European Union’s Horizon Europe research and innovation action under grant agreement No 101057292. Additionally, United Kingdom Research and Innovation (UKRI) has provided funding under the United Kingdom government’s Horizon Europe funding guarantee [grant agreement No 10039823 for Cardiff University and 10038000 for Hull York Medical School]. 2024-10-25T12:17:02.8523190 2024-10-25T09:26:52.0959722 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Mette Søgaard 1 Marie Ørskov 2 Martin Jensen 3 Jamilla Goedegebuur 4 Eva K Kempers 5 Chantal Visser 6 Eric C T Geijteman 7 Denise Abbel 8 Simon P Mooijaart 9 Geert-Jan Geersing 10 Johanneke Portielje 11 Adrian Edwards 12 Sarah Aldridge 13 Ashley Akbari 0000-0003-0814-0801 14 Anette A Højen 15 Frederikus A Klok 16 Simon Noble 17 Suzanne Cannegieter 18 Anne Gulbech Ording 19
title	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.
spellingShingle	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. Sarah Aldridge Ashley Akbari
title_short	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.
title_full	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.
title_fullStr	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.
title_full_unstemmed	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.
title_sort	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.
author_id_str_mv	a42ee8ba1ff8174d5bb62d2d95364b90 aa1b025ec0243f708bb5eb0a93d6fb52
author_id_fullname_str_mv	a42ee8ba1ff8174d5bb62d2d95364b90_*_Sarah Aldridge aa1b025ec0243f708bb5eb0a93d6fb52_*_Ashley Akbari
author	Sarah Aldridge Ashley Akbari
author2	Mette Søgaard Marie Ørskov Martin Jensen Jamilla Goedegebuur Eva K Kempers Chantal Visser Eric C T Geijteman Denise Abbel Simon P Mooijaart Geert-Jan Geersing Johanneke Portielje Adrian Edwards Sarah Aldridge Ashley Akbari Anette A Højen Frederikus A Klok Simon Noble Suzanne Cannegieter Anne Gulbech Ording
format	Journal article
container_title	Journal of Thrombosis and Haemostasis
publishDate	2024
institution	Swansea University
issn	1538-7933 1538-7836
doi_str_mv	10.1016/j.jtha.2024.09.023
publisher	Elsevier B.V.
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	0
active_str	0
description	Despite uncertain benefit-risk profile near the end of life, antithrombotic therapy (ATT) is prevalent in patients with terminal cancer. 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. 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. 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 (DOAC), and 10.4% vitamin K antagonists (VKA)). The mean PDC 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% DOACs, 61.6% VKAs). Patients receiving ATT had a lower one-year VTE risk but higher risks of ATE and major bleeding. Despite uncertain benefit-risk profile, most terminally ill cancer patients continue ATT until the end of life. These findings provide insights into current ATT utilisation and discontinuation dynamics in the challenging context of terminal illness. [Abstract copyright: Copyright © 2024. Published by Elsevier Inc.]
published_date	2024-10-10T12:17:01Z
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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.

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