PB1409 - Understanding European patterns of deprescribing antithrombotic medication during end-of-life care in cancer patients

Background: Even though antithrombotic therapy (ATT) probably has little or even negative effects on the well-being of cancer patients in their final year, it is often continued until death, possibly leading to bleeding complications, increased disease burden, and higher healthcare costs.

Aims: To explore and describe practice patterns across Europe regarding the use of ATT in end-of-life care (EOLC) of cancer patients.

Methods: A two-week, international, cross-sectional survey study using flash-mob research methodology for the SERENITY project, funded by the Horizon Europe program. Eligible were healthcare professionals from different institutions, who prescribed ATT and/or dealt with EOLC of cancer patients. The survey contained self-designed questions and series of choice sets (hypothetical scenarios involving a set of characteristics changing in level (e.g., high vs. low thrombotic risk).

Results: 208 of 467 pre-registrants participated in the survey from July 4-18, 2023 (Table 1). The majority of participants (53%) considered a cancer patient as in EOLC when life expectancy is under 3 months. 20% had never deprescribed ATT in the context of EOLC. The estimated annual frequency of “considering” ATT deprescription was 10 (IQR 4-10), while the estimate for actual deprescription was 5 (IQR 2-10). Five participants (2.7%) found deprescribing inappropriate in any scenario.
Deprescribing was more often considered in patients with poor ECOG-performance status and for low-molecular-weight heparin (LMWH), as opposed to oral ATT, while risk of bleeding and thrombosis seemed less relevant. In scenarios with ECOG score greater than 2 (indicative of limited or no self-care ability), 88% of participants deemed deprescribing ATT most appropriate when LMWH was used in patients with high bleeding and thrombotic risk; no participants chose the oral anticoagulant treatment or antiplatelet treatment scenario.

Conclusion(s): Our study describes medical decision making regarding ATT in EOLC of cancer patients. At the ISTH congress, multinomial regression analyses of the choice sets will be available.