ASIH Stockholm Södra, Specialized home care and Specialized palliative ward, Älvsjö, Sweden.
Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden.
J Palliat Med. 2024 Oct;27(10):1310-1317. doi: 10.1089/jpm.2024.0108. Epub 2024 Jul 8.
Patients in palliative care are often treated with antithrombotics, even in the late stages of disease. Clear guidelines regarding deprescribing are lacking. 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. 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. 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. 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.
接受姑息治疗的患者经常接受抗血栓药物治疗，即使在疾病的晚期也是如此。目前缺乏有关停药的明确指南。本研究的目的是调查生命最后一年抗血栓治疗的出血副作用，并绘制停药时间图。这是一项回顾性队列研究。对在瑞典斯德哥尔摩的姑息治疗病房住院 3 年内死亡的所有患者的医疗记录进行筛选，确定接受抗血栓治疗的患者；从医疗记录中提取出血和因停药导致的副作用的数据。使用对数二项式模型探讨与出血相关的因素。在 1501 名患者中，897 名在生命的最后一年接受了抗血栓治疗（平均年龄 75 岁，41%为女性）。其中，56%的患者一直持续治疗到生命的最后 3 天。在 897 名患者中，144 名（16%）至少有一次出血。与其他癌症类型相比，患有前列腺癌的男性出血风险显著更高，调整后的相对风险为 1.9（95%CI 1.1-3.2）。性别、年龄组、抗血栓药物类型或适应证之间出血风险无差异。两名患者（0.2%）在抗血栓药物停药后出现中风。生命最后一年接受抗血栓治疗与出血风险增加相关。在本队列中，患有前列腺癌的男性似乎比其他群体有更多的出血副作用。很少有患者因停药而出现副作用。
