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. 2025 Jan:245:109205.
doi: 10.1016/j.thromres.2024.109205. Epub 2024 Nov 9.

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

E S L Martens  1 , D Becker  2 , C Abele  2 , D Abbel  3 , W P Achterberg  4 , J J Bax  5 , L Bertoletti  6 , M E Edwards  7 , C Font  8 , A Gava  9 , J Goedegebuur  10 , A A Højen  11 , M V Huisman  1 , M J H A Kruip  12 , I Mahé  13 , S P Mooijaart  14 , M Pearson  15 , K Seddon  16 , S Szmit  17 , S I R Noble  18 , F A Klok  19 , S V Konstantinides  20
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Free article

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

E S L Martens et al. Thromb Res. 2025 Jan.
Free article

Abstract

Background: Even though antithrombotic therapy (ATT) probably has little or even negative effect on the well-being of patients with cancer near the end of life, it is often continued until death, possibly leading to excess bleeding complications, increased disease burden, reduced quality of life and higher healthcare costs.

Aim: To explore and describe European practice patterns and perspectives of healthcare professionals from different disciplines and specialties on ATT in the end-of-life care (EOLC) of patients with cancer.

Methods: We performed a two-week international cross-sectional survey study using flash-mob research methodology. Eligible were healthcare professionals from different institutions across Europe, who prescribed ATT and/or dealt with EOLC of patients with cancer. The survey comprised three parts, including a series of choice sets (hypothetical scenarios involving a set of characteristics changing in level [e.g., high vs. low thrombotic risk]) on ATT management in EOLC. The discrete choice experiment analysis was conducted using multinomial logistic regression.

Results: Out of 467 pre-registrants, 208 participated in the survey from 4 to 18 July 2023. The majority (53 %) considered a patient with cancer as in EOLC when life expectancy is below 3 months. Respondents reported seeing or treating 20 patients with cancer on ATT in EOLC per year (IQR 10-50). The median estimated frequency of considering ATT deprescription per healthcare professional was 10 times per year (IQR 4-10), while the frequency of actual deprescription was 5 times per year (IQR 2-10). Twenty percent of respondents had never deprescribed ATT in the context of EOLC. Across the eight choice sets, five respondents (2.7 %) found deprescribing inappropriate in any scenario. Deprescribing was more often considered in patients with poor ECOG-performance status, high bleeding risk and low-molecular-weight heparin use as opposed to oral ATT. Haemato-oncology and cardiovascular medicine specialists were more inclined to deprescribe antiplatelet therapy than other specialties.

Conclusion: Our study describes medical decision-making regarding ATT in EOLC of patients with cancer. Healthcare professionals' perspectives and practice patterns vary, and some preferences appear associated with the therapists' professional focus and region of practice.

Keywords: Anticoagulants; Antithrombotic agents; Deprescribing; Flash-mob research; Hemorrhage; Neoplasms; Palliative care; Thrombosis.

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Conflict of interest statement

Declaration of competing interest LB reports personal fees from Merck Sharp & Dohme, LEO-Pharma, Bristol-Myers Squibb-Pfizer, and a grant for research from Merck Sharp & Dohme, outside the submitted work. AAH has received research grants from The Danish Heart Foundation and The Novo Nordisk Foundation, has received personal consulting fees from Bayer and has been on the speaker bureaus for Bayer, LEO-Pharma, and Bristol Myers Squibb, all of which are unrelated to this work. MJHAK reports grants from Sobi, The Netherlands Organisation for Health Research and Development, and the Dutch Thrombosis Association, and speaker fees from Roche, Sobi, and Bristol Myers Squibb, all grants and fees were unrelated to this work and paid to her institution. MP reports grants or contracts from the National Institute for Health Research to the Medical Research Council, Marie Curie to Yorkshire Cancer Research, National Health & Medical Research Council to the UKRI Arts & Humanities Research Council, and AstraZeneca to Research England, along with support for attending meetings and/or travel from the All-Ireland Institute of Hospice and Palliative Care. FAK reports grants or contracts from Bayer, Bristol Myers Squibb, British Society of Cardiovascular Imaging, Merck Sharp & Dohme, LEO-Pharma, Actelion, Varm-X, The Netherlands Organisation for Health Research and Development, the Dutch Thrombosis Association, the Dutch Heart Foundation, and the Horizon Europe Program, all unrelated to this work and paid to his institution. SVK reports research funding (grants) and consultation fees via his institution from Bayer AG, Boston Scientific, Inari Medical and Penumbra Inc.; and personal lecture & consultation honoraria/fees from Bayer AG, Boston Scientific, Daiichi-Sankyo and Penumbra Inc. All other authors declared no potential conflicts of interest with respect to the research.

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