Søgaard Mette, Ørskov Marie, Jensen Martin, Goedegebuur Jamilla, Kempers Eva K, Visser Chantal, Geijteman Eric C T, Abbel Denise, Mooijaart Simon P, Geersing Geert-Jan, Portielje Johanneke, Edwards Adrian, Aldridge Sarah J, Akbari Ashley, Højen Anette A, Klok Frederikus A, Noble Simon, Cannegieter Suzanne, Ording Anne Gulbech
Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg University Hospital, Gistrup, Denmark.
Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Department of Ophthalmology, Aalborg University Hospital, Gistrup, Denmark.
J Thromb Haemost. 2025 Jan;23(1):190-200. doi: 10.1016/j.jtha.2024.09.023. Epub 2024 Oct 10.
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, and 10.4% vitamin K antagonists [VKAs]). The mean PDC with ATT 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% direct oral anticoagulants, and 61.6% VKAs). Patients receiving ATT had a lower 1-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 utilization and discontinuation dynamics in the challenging context of terminal illness.
尽管在生命末期抗栓治疗（ATT）的获益风险尚不明确，但在晚期癌症患者中该治疗仍很普遍。
研究晚期癌症患者对ATT的依从性和持续性，并通过ATT暴露情况调查主要及临床相关出血、静脉血栓栓塞（VTE）和动脉血栓栓塞（ATE）的风险。
利用丹麦全国范围的晚期癌症患者队列，通过处方覆盖天数比例（PDC）来衡量末期疾病宣告后一年中患者对ATT的依从性。停药定义为两次处方续签之间≥30天的治疗间隔。考虑到死亡的竞争风险，计算出血并发症、VTE和ATE的一年累积发病率。
在2013年至2022年期间，共识别出86732例晚期癌症患者（中位年龄75岁；47%为女性；中位生存期57天）。在末期疾病宣告时，37.5%的患者正在接受ATT治疗（66.6%为血小板抑制剂，23.0%为直接口服抗凝剂，10.4%为维生素K拮抗剂[VKA]）。ATT的平均PDC为88%（标准差30%），在血小板抑制剂使用者中最高（平均PDC为89%），在VKA使用者中最低（73%）。一年的ATT停药发生率为7.9%（95%置信区间，7.7%-8.1%）。大多数患者持续接受ATT直至死亡（74.8%为血小板抑制剂，58.8%为直接口服抗凝剂，61.6%为VKA）。接受ATT治疗的患者1年VTE风险较低，但ATE和大出血风险较高。
尽管获益风险尚不明确，但大多数晚期癌症患者仍持续接受ATT直至生命结束。这些发现为末期疾病这一具有挑战性的背景下当前ATT的使用和停药动态提供了见解。
