Inserm, CIC 1408, FCRIN-INNOVTE, Saint-Etienne, France.
UMR1059 SAINBIOSE, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France.
J Thromb Haemost. 2017 Mar;15(3):420-428. doi: 10.1111/jth.13606. Epub 2017 Feb 17.
Essentials Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients. We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients). At three months, the cumulative incidence of clinically relevant bleeding was 9.8%. Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.
Background The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown. Objectives Our primary aim was to assess the bleeding risk of patients in a real-world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding. Patients/Methods In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non-major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis. Results The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3-11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2-1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months. Conclusions Decisions regarding the use of thromboprophylaxis in palliative care patients should take into account the high risk of bleeding in these patients.
在姑息治疗住院患者中，出血风险因素未知的情况下，基本的出血发生率作为出血风险因素尚不清楚。目的：我们旨在评估姑息治疗患者的出血风险，方法：这是一项前瞻性、观察性研究，纳入了 22 家法国姑息治疗病房的 1199 名首次因晚期癌症或肺部、心脏或神经系统疾病而入住姑息治疗病房的患者（中位年龄 71 岁，男性占 45.5%）。主要结局是 3 个月时判定的临床相关出血（即主要出血和临床相关非主要出血的复合）。次要结局是症状性深静脉血栓形成和识别出血的危险因素。结果：姑息治疗的最常见原因是癌症（90.7%）。3 个月时，1087 名患者（91.3%）死亡，116 名患者至少出现 1 次临床相关出血（23 名患者为致命性出血）。考虑到死亡的竞争风险，临床相关出血的累积发生率为 9.8%（95%CI，8.3-11.6）。6 名患者发生深静脉血栓形成（累积发生率 0.5%；95%CI，0.2-1.1）。癌症、近期出血、抗血栓形成预防和抗血小板治疗与 3 个月时的临床相关出血独立相关。结论：在姑息治疗患者中使用抗血栓形成预防措施的决策应考虑到这些患者出血风险高。
