OC 64.5 - Antithrombotic therapy and its discontinuation in patients with cancer during their last phase of life: a primary care cohort study from the SERENITY consortium

Tuesday, June 25, 2024

15:45 – 16:00 ICT

Room: Ballroom B4

Presenting Author(s)

DA

Denise Abbel

MSc
Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

ET

Emmy M. Trinks-Roerdink

MD, PhD
Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Utrecht, Utrecht, Netherlands
Suzanne C. Cannegieter

MD, PhD, prof
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Leiden, Zuid-Holland, Netherlands
Jamilla Goedegebuur, MD

PhD candidate
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
JG

Jacobijn Gussekloo

MD, PhD, prof
Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands
Erik Klok, MD, PhD, FESC

Leiden University Medical Center
SM

Simon Mooijaart

MD, PhD, prof
Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands
Simon I.R. Noble

MBBS, MD, FRCP
Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, United Kingdom.
Cardiff, Wales, United Kingdom
JP

Johanneke Portielje

MD, PhD
Department of Internal Medicine, section of Medical Oncology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
ST

Stella Trompet

PhD
Department of Internal Medicine – section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands
Geert-Jan Geersing

MD, PhD, associate prof
Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Utrecht, Utrecht, Netherlands
Cv

Carline van den Dries

MD, PhD
Department of General Practice & Nursing Science, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Utrecht, Utrecht, Netherlands

Background: Antithrombotic therapy (ATT) is challenging in cancer patients during end-of-life and it is uncertain if end-of-life patients still benefit from ATT. Little is known about ATT discontinuation rates and the incidence of thrombosis and bleeding events in cancer patients in their last phase of life.

Aims: To investigate the prevalence of ATT use in end-of-life cancer patients in primary care and the occurrence of ATT discontinuation, bleeding and thrombotic events.

Methods: We performed a retrospective study using the routine health care database of the Julius General Practitioners’ (GPs) Network. Between 2013 and 2023 data from GP consultations with end-of-life cancer patients were retrieved. The moment of the first initiation of specific GP reimbursement claims for palliative care was considered as start of the end-of-life phase. Using international Classification of Primary Care (ICPC) codes, clinically relevant bleeding and thrombotic events were identified. ATT use was based on Anatomical Therapeutic Chemical Classification System (ATC) codes from routine care pharmacist data.

Results: In total, 6281 patients with cancer with a mean age of 74 (12.8) years were included and the median duration of palliative GP care before death was 45 (interquartile range (IQR): 14-184) days. A total of 2290 (36.5%) patients used ATT at baseline and 764 (33.4%) users stopped ATT at a median of 28 (IQR: 9-92) days before death. Index ATT users had a higher overall percentage of arterial thrombosis (2.3% vs 0.3%), venous thrombosis (1.6% vs 0.9%), and bleeding events (4.1% vs 2.2%) than non-index ATT users during the palliative GP care period.

Conclusion(s): About a third of cancer patients used ATT at the start of palliative care, which a third of the patients discontinued. Reasons for discontinuation are a subject of further research. Index ATT users more often had thrombotic or bleeding events compared to ATT non-users.