Gurumurthy, Gerard, Kumar, Naisthika, Reynolds, Lianna, Bassam, Biddy, Carrier, Marc, Noble, Simon  ORCID: https://orcid.org/0000-0001-5425-2383, Khorana, Alok A. and Thachil, Jecko
2026.
Antithrombotic therapy at the end of life - continue or stop?
Research and Practice in Thrombosis and Haemostasis
10
(3)
, 103459.
10.1016/j.rpth.2026.103459
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Abstract
Antithrombotics at the end of life poses a clinical challenge where indication-specific time-to-benefit, bleeding risk, and patient priorities must be reconciled over short prognostic horizons. In this review of the literature, we found that a substantial number of individuals remain on anticoagulants and anti-platelet therapy till the point of death. Prospective ultrasound surveillance studies show a high baseline prevalence of asymptomatic proximal deep-vein thrombosis at admission but a low short-term incidence of new events during typical hospice stays. Additionally, large home palliative cohorts suggest that deprescribing anticoagulants does not increase clinical thrombosis and may reduce bleeding and facilitate home death. Bleeding on antithrombotics is also common in the last months of life. Clinically relevant bleeding occurs in up to one in ten and fatal haemorrhage has been reported. Cancer-specific factors, chronic/end-stage kidney disease, cytopenias, and drug interactions heighten the risks. Where anticoagulation is pursued, the choice of agent and route should reflect swallowing, nutrition, renal/hepatic function, monitoring capacity and reversal intent. Structured, shared decision-making and proactive deprescribing when benefits no longer outweigh harms are central.
| Item Type: | Article |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Schools > Medicine |
| Publisher: | Wiley |
| ISSN: | 2475-0379 |
| Date of First Compliant Deposit: | 7 April 2026 |
| Date of Acceptance: | 20 March 2026 |
| Last Modified: | 14 May 2026 10:51 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/186186 |
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