PB0981 - Vitamin K antagonist treatment quality in the last year of life: a multicentre observational cohort

Tuesday, June 25, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Chantal Visser, MD

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

Co-Author(s)

Eva K. Kempers

PhD candidate
Erasmus University Medical Center, Rotterdam
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: Limited evidence on the safety and effectiveness of vitamin K antagonists (VKA) in patients approaching the end of life complicates decisions regarding (dis)continuing VKA treatment.

Aims: To describe VKA treatment quality in the last year of life for patients with severe medical conditions.

Methods: Prevalent VKA users from five Dutch anticoagulation clinics, who were hospitalized with a prespecified severe medical conditions between 1/1/2013-31/12/2019 and died before 01/01/2020 were included. Using INR data between the index hospitalization and death, we calculated measures of VKA treatment quality, including time in/above/below therapeutic range (TTR/TAR/TBR) and INR variance growth rate (VGR, reflecting the degree of deviation between two consecutive INR measurements). We calculated these measures within four intervals (0-1 year, 0-9 months, 0-6 months and 0-3 months preceding death) for continuously treated VKA users and within the 9-12th, 6-9th, 3-6th and 0-3rd month before death for all VKA users treated with VKA in the year before death, stratified by follow-up time (≥365 and 180-364 days). SERENITY is funded by Horizon Europe Research And Innovations.

Results: 7442 VKA users in their last year of life were identified, with a median age of 82.0 [IQR 76.0-87.0] years and 3968 (53.3%) males. The most common severe medical conditions were heart disease (60.3%), hip fracture (17.4%), and cancer (16.8%). As the time window narrowed from 12 to 3 months before death, the TTR declined, while both TAR and TBR increased (Figure 1). In subcohorts with ≥365 and 180-364 days follow-up, both TTR and TBR decreased as death approached, while TAR increased (Figure 2A-B). VGR remained constant in all analyses, indicating consistent INR variability, despite the increased time out of range closer to death.

Conclusion(s): VKA treatment quality declined in the year preceding death, marked by reduced TTR and substantially increased TAR, indicating a potential heightened risk of bleeding events.