Anti‐thrombotic therapy in patients with cancer at the end of life: A cohort study using population‐linked routinely collected data
Anti-thrombotic therapy (ATT) in cancer patients approaching the end of life presents significant clinical challenges, balancing thrombotic and bleeding risks. This study analysed ATT prescribing patterns and associated outcomes in patients diagnosed with poor prognosis cancer, defined as cancer diagnoses associated with a 1-year life expectancy, using the Welsh national Secure Anonymised Information Linkage Databank. Retrospective cohort study of adults in Wales diagnosed with poor prognosis cancer between 2013 and 2021, following up patients from cancer diagnosis until death, end of follow-up or study end (31 December 2021). Outcomes included ATT discontinuation, bleeding and thromboembolic events in secondary care. We identified a cohort of 25 783 adults with a median survival of 145 days. Of these, 32% were receiving ATT at diagnosis, with 77% continuing until death. One-year cumulative incidence of ATT discontinuation was 19% (95% CI: 18%-20%). The 1-year cumulative incidence of bleeding was 3.2% (95% CI: 3.0%-3.4%) and of thromboembolic events was 5.3% (95% CI: 5.0%-5.6%). ATT was prevalent at cancer diagnosis and discontinuation before death was uncommon. The management of ATT is complex in patients with advanced cancer and there is a need for clearer guidance on appropriate discontinuation strategies as well as when to continue these medicines.
Authors
- Anne Gulbech Ording (ORCID: https://orcid.org/0000-0002-8073-7664)
- Carline J. van den Dries (ORCID: https://orcid.org/0000-0001-7602-3522)
- Sebastian Szmit (ORCID: https://orcid.org/0000-0002-3075-1943)
- Isabelle Mahé (ORCID: https://orcid.org/0000-0003-1760-7880)
- Suzanne C. Cannegieter (ORCID: https://orcid.org/0000-0003-4707-2303)
- Chantal Visser (ORCID: https://orcid.org/0000-0002-2025-1734)
- Marieke J. H. A. Kruip (ORCID: https://orcid.org/0000-0002-0265-4871)
- Ashley Akbari (ORCID: https://orcid.org/0000-0003-0814-0801)
- Eric C. T. Geijteman (ORCID: https://orcid.org/0000-0001-7354-2220)
- Geert‐Jan Geersing (ORCID: https://orcid.org/0000-0001-6976-9844)
- Sarah J Aldridge (ORCID: https://orcid.org/0000-0002-5158-1242)
- Eva K Kempers (ORCID: https://orcid.org/0000-0001-9458-8674)
- Adrian Edwards (ORCID: https://orcid.org/0000-0002-6228-4446)
- Frederikus Albertus Klok (ORCID: https://orcid.org/0000-0001-9961-0754)
- Kate Lifford (ORCID: https://orcid.org/0000-0002-9782-2080)
- Simon Noble (ORCID: https://orcid.org/0000-0001-5425-2383)
- Mette Søgaard (ORCID: https://orcid.org/0000-0002-2830-4968)
- Denise Abbel (ORCID: https://orcid.org/0000-0002-7111-6604)
- Jamilla Goedegebuur (ORCID: https://orcid.org/0000-0001-9571-7431)
- Simon P. Mooijaart (ORCID: https://orcid.org/0000-0003-3106-3568)
Institutions
- Université Paris Cité (FR)
- Aalborg University Hospital (DK)
- Leiden University Medical Center (NL)
- Erasmus MC (NL)
- University Medical Center Utrecht (NL)
- Swansea University (GB)
- Hôpital Louis-Mourier (FR)
- Postgraduate School of Molecular Medicine (PL)
- Cardiff University (GB)
- Cardiff Metropolitan University (GB)
- Aalborg University (DK)
- Erasmus University Rotterdam (NL)
- University of Wales (GB)
Publication Details
- Journal
- British Journal of Haematology
- Published
- 2025-09-01
- DOI
- https://doi.org/10.1111/bjh.70032
- Citations
- 4
- Primary Topic
- Venous Thromboembolism Diagnosis and Management
- Type
- article
- Field-Weighted Citation Impact
- 7.48
Funders
- UK Research and Innovation
- HORIZON EUROPE European Innovation Council