Antithrombotic treatment the last year of life is associated with a high risk of bleeding in men with prostate cancer, with clinical markers of increased vulnerability including low thrombocyte count, need for blood transfusion, and deep venous thrombosis treatment.
A large proportion of men with end-stage prostate cancer were treated with antithrombotics in the last year of life.
Bleeding occurred in 37.5% of men with end-stage prostate cancer who were treated with antithrombotics during the last year of life.
Need for blood transfusion was associated with significantly increased vulnerability for bleeding in men on antithrombotic treatment.
Low thrombocyte count was associated with increased vulnerability for bleeding in men with prostate cancer on antithrombotics.
Deep venous thrombosis (DVT) treatment was associated with increased vulnerability for bleeding.
Age, type of antithrombotic, use of steroids, and NSAID use were not identified as risk factors for bleeding.
This research suggests that men with advanced prostate cancer who are treated with blood-thinning medications (antithrombotics) face a very high risk of bleeding in the last year of their lives. In this study of 64 such men receiving palliative care, more than one in three (37.5%) experienced a bleeding episode. Notably, half of these patients were still receiving blood thinners in the final week of their lives, raising questions about whether the benefits of continuing these medications outweigh the risks at the very end of life. The study identified specific warning signs that indicate which patients are at greatest risk of bleeding: having a low platelet (thrombocyte) count, needing blood transfusions, and being treated for deep vein thrombosis (DVT). Each of these factors more than doubled the risk of bleeding. Importantly, factors that might seem relevant — such as the patient's age, the specific type of blood thinner used, or whether the patient was taking steroids or anti-inflammatory drugs — were not found to be associated with increased bleeding risk. This research suggests that clinicians caring for men with advanced prostate cancer on blood thinners should pay close attention to platelet counts and transfusion needs as signals that a patient may be particularly vulnerable to bleeding complications. These findings could help guide conversations about whether to continue, reduce, or stop antithrombotic therapy as patients approach the end of life, though such decisions require careful individualized consideration by healthcare teams.
Björkhem-Bergman L, Hedman C, Szilcz M, Frisk G. (2026). Clinical Markers of Vulnerability for Bleeding in Men With Prostate Cancer and Antithrombotic Treatment.. Cancer reports (Hoboken, N.J.). https://doi.org/10.1002/cnr2.70720