Abbel, Denise, Geersing, Geert-Jan, Trinks-Roerdink, Emmy M., Aldridge, Sarah J., Edwards, Adrian  ORCID: https://orcid.org/0000-0002-6228-4446 and Noble, Simon ORCID: https://orcid.org/0000-0001-5425-2383
2026.
Antithrombotic therapy discontinuation, bleeding, and thromboembolic events in patients with cancer during the last phase of life: Insights from primary care records.
Annals of Family Medicine
24
(2)
, pp. 104-110.
10.1370/afm.250461
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Abstract
PURPOSE It is unclear whether patients with cancer continue to benefit from antithrombotic therapy (ATT) during the last phase of life. We estimated the incidences of ATT discontinuation, bleeding, and venous thromboembolic (VTE) and arterial thromboembolic (ATE) events among patients with cancer during the last phase of life. METHODS We included patients aged ≥18 years with cancer during the period 2018 to 2022 at the time a reimbursement claim for general practitioner (GP) palliative care was made. We manually identified ATT discontinuation, along with reasons, and the incidences of bleeding events, VTE events, and ATE events in free-text reports of routine primary care consultations until death. RESULTS Among the 2,860 included patients, 32.5% used ATT at the index date. The median follow-up was 43 (interquartile range [IQR] 14-190) days for ATT users and 42 (IQR 13-149) days for nonusers. During follow-up, 22.1% of ATT users discontinued ATT, with a median of 8 (IQR 3-26) days before death. The most common reason for discontinuation was recognition of the terminal phase (22.9%). 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, and ATE events occurred for 2.5% (95% CI, 1.7%-3.7%) of ATT users and 1.9% (95% CI, 1.4%-2.6%) nonusers. DISCUSSION One-third of patients with cancer used ATT at the initiation of GP palliative care, with most continuing treatment until death or discontinuing shortly before death. Bleeding events largely outnumbered ATE and VTE events among both ATT users and non-users. These findings provide new insights into ATT management by GPs and inform future research on optimizing ATT use for patients with cancer during the last phase of life.
| Item Type: | Article |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Schools > Medicine |
| Additional Information: | Full author list available at DOI |
| Publisher: | Annals of Family Medicine |
| ISSN: | 1544-1709 |
| Date of First Compliant Deposit: | 1 April 2026 |
| Date of Acceptance: | 3 November 2025 |
| Last Modified: | 20 May 2026 06:45 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/186132 |
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