Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data

Aldridge, Sarah J., Akbari, Ashley, Edwards, Adrian ORCID: https://orcid.org/0000-0002-6228-4446, Lifford, Kate J. ORCID: https://orcid.org/0000-0002-9782-2080, Abbel, Denise, Cannegieter, Suzanne, Goedegebuur, Jamilla, Kempers, Eva K., Søgaard, Mette, Visser, Chantal, Geersing, Geert‐Jan, Kruip, Marieke J. H., Ording, Anne Gulbech, van den Dries, Carline, Geijteman, Eric C. T., Klok, Erik, Mahé, Isabelle, Mooijaart, Simon P., Szmit, Sebastian and Noble, Simon ORCID: https://orcid.org/0000-0001-5425-2383 2025. Anti‐thrombotic therapy in patients with cancer at the end of life and associated clinical outcomes: A cohort study using population‐linked routinely collected data. British Journal of Haematology 10.1111/bjh.70032

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Abstract

Summary: 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.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/
Publisher:	Wiley
ISSN:	0007-1048
Date of First Compliant Deposit:	10 September 2025
Date of Acceptance:	14 July 2025
Last Modified:	10 Sep 2025 08:30
URI:	https://orca.cardiff.ac.uk/id/eprint/181024

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