Treatment with Antithrombotics in the Last Year of Life—Incidence of Bleeding and Side Effects After Deprescribing
(2024) In Journal of Palliative Medicine 27(10). p.1310-1317- Abstract
Background: Patients in palliative care are often treated with antithrombotics, even in the late stages of disease. Clear guidelines regarding deprescribing are lacking. Objective: The aims of this study were to investigate bleeding as a side effect of antithrombotic treatments the last year in life and map the timing of deprescribing. Methods: A retrospective cohort study was performed. All medical records were screened for deceased patients admitted to a palliative care unit in Stockholm, Sweden, over a 3-year period. Patients with antithrombotics were identified; data on bleeding, and on side effects due to deprescribing, were extracted from the medical records. Log-binomial models were used to explore factors associated with... (More)
Background: Patients in palliative care are often treated with antithrombotics, even in the late stages of disease. Clear guidelines regarding deprescribing are lacking. Objective: The aims of this study were to investigate bleeding as a side effect of antithrombotic treatments the last year in life and map the timing of deprescribing. Methods: A retrospective cohort study was performed. All medical records were screened for deceased patients admitted to a palliative care unit in Stockholm, Sweden, over a 3-year period. Patients with antithrombotics were identified; data on bleeding, and on side effects due to deprescribing, were extracted from the medical records. Log-binomial models were used to explore factors associated with bleeding. Results: Of 1501 patients, 897 were treated with antithrombotics during the last year of life (mean age 75 years, 41% women). Of these, 56% continued treatment up until the last 3 days of life. Of the 897 patients, 144 (16%) had at least one bleeding during the treatment. The risk for bleeding was significantly higher for men with prostate cancer compared to other cancer forms, adjusted relative risk 1.9 (95% CI 1.1–3.2). No difference in risk for bleeding was found between sex, age groups, type of antithrombotics, or indication. Two patients (0.2%) developed strokes after antithrombotics were deprescribed. Conclusions: Treatment with antithrombotics during the last year of life is associated with a high risk of bleeding. In this cohort, men with prostate cancer seemed to have more side effects of bleeding than other groups. Few experienced side effects from deprescribing.
(Less)
- author
- Frisk, Gabriella ; Szilcz, Máté ; Hedman, Christel LU and Björkhem-Bergman, Linda
- organization
- publishing date
- 2024-10
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- antithrombotics, deprescribing, end of life, palliative care
- in
- Journal of Palliative Medicine
- volume
- 27
- issue
- 10
- pages
- 8 pages
- publisher
- Mary Ann Liebert, Inc.
- external identifiers
-
- pmid:38973710
- scopus:85198648977
- ISSN
- 1096-6218
- DOI
- 10.1089/jpm.2024.0108
- language
- English
- LU publication?
- yes
- id
- 38a171bb-cf30-4e00-8ea2-9cd6fa69dc0b
- date added to LUP
- 2024-11-28 12:29:13
- date last changed
- 2025-07-11 07:19:51
@article{38a171bb-cf30-4e00-8ea2-9cd6fa69dc0b,
abstract = {{<p>Background: Patients in palliative care are often treated with antithrombotics, even in the late stages of disease. Clear guidelines regarding deprescribing are lacking. Objective: The aims of this study were to investigate bleeding as a side effect of antithrombotic treatments the last year in life and map the timing of deprescribing. Methods: A retrospective cohort study was performed. All medical records were screened for deceased patients admitted to a palliative care unit in Stockholm, Sweden, over a 3-year period. Patients with antithrombotics were identified; data on bleeding, and on side effects due to deprescribing, were extracted from the medical records. Log-binomial models were used to explore factors associated with bleeding. Results: Of 1501 patients, 897 were treated with antithrombotics during the last year of life (mean age 75 years, 41% women). Of these, 56% continued treatment up until the last 3 days of life. Of the 897 patients, 144 (16%) had at least one bleeding during the treatment. The risk for bleeding was significantly higher for men with prostate cancer compared to other cancer forms, adjusted relative risk 1.9 (95% CI 1.1–3.2). No difference in risk for bleeding was found between sex, age groups, type of antithrombotics, or indication. Two patients (0.2%) developed strokes after antithrombotics were deprescribed. Conclusions: Treatment with antithrombotics during the last year of life is associated with a high risk of bleeding. In this cohort, men with prostate cancer seemed to have more side effects of bleeding than other groups. Few experienced side effects from deprescribing.</p>}},
author = {{Frisk, Gabriella and Szilcz, Máté and Hedman, Christel and Björkhem-Bergman, Linda}},
issn = {{1096-6218}},
keywords = {{antithrombotics; deprescribing; end of life; palliative care}},
language = {{eng}},
number = {{10}},
pages = {{1310--1317}},
publisher = {{Mary Ann Liebert, Inc.}},
series = {{Journal of Palliative Medicine}},
title = {{Treatment with Antithrombotics in the Last Year of Life—Incidence of Bleeding and Side Effects After Deprescribing}},
url = {{http://dx.doi.org/10.1089/jpm.2024.0108}},
doi = {{10.1089/jpm.2024.0108}},
volume = {{27}},
year = {{2024}},
}