PB0983 - Frequency of discontinuation of vitamin K antagonists and occurrence of bleeding and thromboembolic events in long-term users with a limited life expectancy

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Eva K. Kempers

PhD candidate
Erasmus University Medical Center, Rotterdam
Rotterdam, Zuid-Holland, Netherlands

Co-Author(s)

Chantal Visser, MD

PhD-candidate
Department of Haematology, Erasmus MC, Erasmus University Medical Center, Rotterdam, the Netherlands
Rotterdam, Zuid-Holland, Netherlands
EG

Eric C. T. Geijteman

MD PhD
Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
Rotterdam, Zuid-Holland, Netherlands
NW

Nynke M. Wiersma

MD
Diagnostic Center Saltro, Department of Thrombosis and Anticoagulation, Utrecht, the Netherlands
Utrecht, Utrecht, Netherlands
AB

Annelies Boetes-Draisma

MD PhD
Thrombosis Service Star-shl, Rotterdam, The Netherlands
Rotterdam, Zuid-Holland, Netherlands
Sv

Sjef J.C.M. van de Leur

MD PhD
Thrombosis Service, Isala Hospital Zwolle, Zwolle, the Netherlands
Zwolle, Overijssel, Netherlands
MN

Melchior C. Nierman

MD PhD
Thrombosis Service of Amsterdam (Atalmedial), Amsterdam, the Netherlands
Amsterdam, Noord-Holland, Netherlands
Simon I.R. Noble

MBBS, MD, FRCP
Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, United Kingdom.
Cardiff, Wales, United Kingdom
Erik Klok, MD, PhD, FESC

Leiden University Medical Center
MK

Marieke J.H.A. Kruip

Hematologist
Department of Hematology, Erasmus MC, Erasmus University Medical Centre Rotterdam, Rotterdam, the Netherlands
Rotterdam, Zuid-Holland, Netherlands
Qingui Chen, MD PhD

Post doc
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Suzanne C. Cannegieter

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

Background: In patients with an indication for long-term vitamin K antagonists (VKA) and limited life expectancy, data on its discontinuation and its safety and efficacy are lacking.

Aims: This large-scale cohort study aimed to describe (1) discontinuation of VKA and (2) incidences of bleeding and thromboembolic events in VKA users with a limited life expectancy.

Methods: Data from five Dutch anticoagulation clinics were linked to data from Statistics Netherlands and the Netherlands Cancer registry. Prevalent VKA users between 1/1/2013-31/12/2019 who were hospitalized or diagnosed with a pre-specified severe medical condition were included and followed until 31/12/2019. Bleeding and thromboembolic events were identified based on hospitalization data. Cumulative incidences of VKA discontinuation and adverse events were calculated taking death as competing risk into account, as well as incidence rates for VKA exposed and unexposed person-years (PY).

Results: 14865 VKA users were included, with a median age at index date of 80 years (IQR 73-86) and a median survival time of 2.95 years (95%CI 2.88-3.05). The most frequent conditions included heart disease (63.0%), hip fracture (17.4%), and cancer (11.4%). Cumulative incidences of VKA discontinuation at year 1 and year 6 were 11.6% (95%CI 11.1-12.1) and 26.8% (95%CI 25.8-27.8), respectively. Among patients who died, the proportion of patients on VKA decreased as death approached, but remained high (Figure 1). The 6-year cumulative incidences of first bleeding and thromboembolic events ranged from 0.5%-8.7% (Figure 2). Incidence rates were lower during VKA use than after discontinuation for bleeding (2.47 vs 2.64 per 100 PY), venous (0.17 vs 0.23 per 100 PY) and arterial thromboembolism (2.98 vs 3.75 per 100 PY).

Conclusion(s): A large proportion of long-term VKA users continued using during the last phase of life. The incidence of adverse events appeared to be low, both when continued or discontinued VKA.
SERENITY is funded by Horizon Europe Research And Innovations.