Martens E S L, Becker D, Abele C, Abbel D, Achterberg W P, Bax J J, Bertoletti L, Edwards M E, Font C, Gava A, Goedegebuur J, Højen A A, Huisman M V, Kruip M J H A, Mahé I, Mooijaart S P, Pearson M, Seddon K, Szmit S, Noble S I R, Klok F A, Konstantinides S V
Department of Medicine - Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
Thromb Res. 2025 Jan;245:109205. doi: 10.1016/j.thromres.2024.109205. Epub 2024 Nov 9.
Even though antithrombotic therapy (ATT) probably has little or even negative effect on the well-being of patients with cancer near the end of life, it is often continued until death, possibly leading to excess bleeding complications, increased disease burden, reduced quality of life and higher healthcare costs.
To explore and describe European practice patterns and perspectives of healthcare professionals from different disciplines and specialties on ATT in the end-of-life care (EOLC) of patients with cancer.
We performed a two-week international cross-sectional survey study using flash-mob research methodology. Eligible were healthcare professionals from different institutions across Europe, who prescribed ATT and/or dealt with EOLC of patients with cancer. The survey comprised three parts, including a series of choice sets (hypothetical scenarios involving a set of characteristics changing in level [e.g., high vs. low thrombotic risk]) on ATT management in EOLC. The discrete choice experiment analysis was conducted using multinomial logistic regression.
Out of 467 pre-registrants, 208 participated in the survey from 4 to 18 July 2023. The majority (53 %) considered a patient with cancer as in EOLC when life expectancy is below 3 months. Respondents reported seeing or treating 20 patients with cancer on ATT in EOLC per year (IQR 10-50). The median estimated frequency of considering ATT deprescription per healthcare professional was 10 times per year (IQR 4-10), while the frequency of actual deprescription was 5 times per year (IQR 2-10). Twenty percent of respondents had never deprescribed ATT in the context of EOLC. Across the eight choice sets, five respondents (2.7 %) found deprescribing inappropriate in any scenario. Deprescribing was more often considered in patients with poor ECOG-performance status, high bleeding risk and low-molecular-weight heparin use as opposed to oral ATT. Haemato-oncology and cardiovascular medicine specialists were more inclined to deprescribe antiplatelet therapy than other specialties.
Our study describes medical decision-making regarding ATT in EOLC of patients with cancer. Healthcare professionals' perspectives and practice patterns vary, and some preferences appear associated with the therapists' professional focus and region of practice.
尽管抗栓治疗（ATT）可能对临终癌症患者的健康影响甚微甚至产生负面影响，但该治疗往往持续到患者死亡，这可能导致出血并发症增加、疾病负担加重、生活质量下降以及医疗成本上升。
探讨并描述欧洲不同学科和专业的医疗保健专业人员在癌症患者临终关怀（EOLC）中对抗栓治疗的实践模式和观点。
我们采用快闪研究方法进行了为期两周的国际横断面调查研究。符合条件的是来自欧洲各地不同机构、开具抗栓治疗药物和/或处理癌症患者临终关怀的医疗保健专业人员。该调查包括三个部分，其中包括一系列关于临终关怀中抗栓治疗管理的选择集（涉及一组水平变化特征的假设情景，如高血栓形成风险与低血栓形成风险）。使用多项逻辑回归进行离散选择实验分析。
在467名预先登记者中，有208人于2023年7月4日至18日参与了调查。大多数人（53%）认为预期寿命低于3个月的癌症患者处于临终关怀阶段。受访者报告称，他们每年在临终关怀中诊治20名接受抗栓治疗的癌症患者（四分位距为10 - 50）。每位医疗保健专业人员考虑停用抗栓治疗的估计频率中位数为每年10次（四分位距为4 - 10），而实际停用频率为每年5次（四分位距为2 - 10）。20%的受访者在临终关怀背景下从未停用过抗栓治疗。在八个选择集中，有五名受访者（2.7%）认为在任何情景下停用抗栓治疗都是不合适的。与口服抗栓治疗相比，对于美国东部肿瘤协作组（ECOG）体能状态差、出血风险高且使用低分子量肝素的患者，更常考虑停用抗栓治疗。血液肿瘤学和心血管医学专家比其他专业更倾向于停用抗血小板治疗。
我们的研究描述了癌症患者临终关怀中抗栓治疗的医疗决策。医疗保健专业人员的观点和实践模式各不相同，一些偏好似乎与治疗师的专业重点和执业地区有关。
