Polesello Stefano, Georgescu Sebastian, Malagón Talía, Bouchard Sylvie
Department of Palliative Medicine, McGill University, Montreal, Quebec, Canada.
Department of Oncology, Division of Cancer Epidemiology, McGill University, Montreal, Quebec, Canada.
Palliat Med Rep. 2023 Feb 20;4(1):41-48. doi: 10.1089/pmr.2022.0069. eCollection 2023.
Several patients admitted to palliative care residences are on anticoagulotherapy (AC). Given the risks of venous thromboembolism (VTE) and bleeding, the decision to continue or stop AC on admission remains clinically challenging.
To determine the prevalence of AC use and incidence of suspected VTE and bleeding events in palliative care patients.
Retrospective cohort study including all deceased patients at a Canadian palliative care residence over two years.
Among the 453 patients' charts reviewed (369 with cancer), 183 (40%) were on AC at admission or <30 days earlier. Only 64 (35%) continued AC, with 78% discontinuing it during their stay. Demographic parameters were similar in the AC and non-AC groups. The incidence of suspected VTE was lower in patients pursuing AC post-admission than in those who stopped: (4.6% vs. 6.7%) and, conversely, the incidence of bleeding was higher in patients on AC: (10.8% vs. 7.6%), though these differences were not statistically significant. The risk of death in cancer patients within 72 hours of suspected VTE or bleeding event was 80% and 30%, respectively. Patients on AC had a 33% reduced risk of VTE but a 44% increased risk of bleeding.
This study provides information on the AC use in palliative care patients. In term of survivorship, it suggests a possible advantage to continue AC to prevent a symptomatic or distressing death. Given the low incidence of events, larger powered studies will be necessary to further characterize the risks/benefits of pursuing AC in patients in palliative care residences.
入住姑息治疗机构的部分患者正在接受抗凝治疗（AC）。鉴于静脉血栓栓塞（VTE）和出血的风险，入院时继续或停止抗凝治疗的决定在临床上仍然具有挑战性。
确定姑息治疗患者中抗凝治疗的使用 prevalence 以及疑似 VTE 和出血事件的发生率。
回顾性队列研究，纳入了加拿大一家姑息治疗机构两年内所有死亡患者。
在审查的453份患者病历中（369例患有癌症），183例（40%）在入院时或入院前<30天接受抗凝治疗。只有64例（35%）继续接受抗凝治疗，78%的患者在住院期间停止了治疗。抗凝治疗组和非抗凝治疗组的人口统计学参数相似。入院后接受抗凝治疗的患者疑似VTE的发生率低于停止治疗的患者：（4.6%对6.7%），相反，接受抗凝治疗的患者出血发生率更高：（10.8%对7.6%），尽管这些差异无统计学意义。疑似VTE或出血事件发生后72小时内，癌症患者的死亡风险分别为80%和30%。接受抗凝治疗的患者VTE风险降低33%，但出血风险增加44%。
本研究提供了关于姑息治疗患者抗凝治疗使用情况的信息。就生存率而言，这表明继续抗凝治疗以预防有症状或痛苦死亡可能具有优势。鉴于事件发生率较低，需要更大规模的研究来进一步描述姑息治疗机构患者接受抗凝治疗的风险/益处。
