Antithrombotic Therapy Discontinuation, Bleeding, and Thromboembolic Events in Patients With Cancer During the Last Phase of Life: Insights From Primary Care Records.

Approximately one-third of patients with cancer used antithrombotic therapy at the time a reimbursement claim for GP palliative care was made.

• Among 2,860 included patients, 32.5% used ATT at the index date.
• Patients were aged ≥18 years with cancer during the period 2018 to 2022.
• The index date was defined as the time a reimbursement claim for general practitioner palliative care was made.
• Median follow-up was 43 (IQR 14-190) days for ATT users and 42 (IQR 13-149) days for nonusers.

Most ATT users either continued treatment until death or discontinued ATT shortly before death, with only 22.1% discontinuing during follow-up.

• During follow-up, 22.1% of ATT users discontinued ATT.
• The median time from discontinuation to death was 8 (IQR 3-26) days.
• The most common reason for discontinuation was recognition of the terminal phase, accounting for 22.9% of discontinuations.
• Discontinuation data and reasons were manually identified from free-text reports of routine primary care consultations.

Bleeding events occurred more frequently than thromboembolic events among both ATT users and non-users during the last phase of life.

• Bleeding occurred for 28.5% (95% CI, 25.7%-31.5%) of ATT users and 22.0% (95% CI, 20.2%-23.9%) of nonusers.
• Venous thromboembolic events occurred for 3.1% (95% CI, 2.2%-4.4%) of ATT users and 3.0% (95% CI, 2.3%-3.9%) of nonusers.
• Arterial thromboembolic events occurred for 2.5% (95% CI, 1.7%-3.7%) of ATT users and 1.9% (95% CI, 1.4%-2.6%) of nonusers.
• Bleeding events largely outnumbered ATE and VTE events in both groups.

VTE and ATE event rates were similarly low regardless of antithrombotic therapy use.

• VTE events occurred in 3.1% of ATT users versus 3.0% of nonusers.
• ATE events occurred in 2.5% of ATT users versus 1.9% of nonusers.
• The confidence intervals for VTE and ATE events overlapped substantially between ATT users and nonusers.
• Events were identified from free-text reports in routine primary care consultations until death.

The study population was drawn from routine primary care records in patients with cancer who had initiated GP palliative care between 2018 and 2022.

• A total of 2,860 patients were included.
• Inclusion required age ≥18 years, a cancer diagnosis, and a reimbursement claim for GP palliative care.
• ATT discontinuation, bleeding, VTE, and ATE events were manually identified from free-text reports of routine primary care consultations.
• The study period was 2018 to 2022.