What is the clinical evidence from this study?

Study design: Observational. Population: Cancer during the last phase of life (n=2860). Intervention: Antithrombotic therapy (ATT) vs. No antithrombotic therapy. Primary outcome: Incidence of bleeding events.

What question did this study set out to answer?

Assess the benefits of antithrombotic therapy in patients with cancer during the last phase of life.

March 26, 2026Open Access

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

Key Result

In patients with cancer during the last phase of life, bleeding occurred in 28.5% of antithrombotic therapy users and 22.0% of nonusers, largely outnumbering thromboembolic events.

Key Points

Assess the benefits of antithrombotic therapy in patients with cancer during the last phase of life.
Included patients aged ≥18 years with cancer receiving GP palliative care from 2018-2022.
Manually identified cases of ATT discontinuation and associated reasons.
Analyzed incidences of bleeding, venous thromboembolic, and arterial thromboembolic events from routine care records.
32.5% of patients used antithrombotic therapy at the start of care.
22.1% of ATT users discontinued treatment, typically shortly before death.
Bleeding events were reported in 28.5% of ATT users and 22.0% of non-users.

Study Design

Type

Observational (n=2,860)

Multicenter

Yes

Structured PICO

Does antithrombotic therapy use affect the incidence of bleeding and thromboembolic events in patients with cancer during the last phase of life?

Population

2,860 adults (≥18 years) with active cancer (excluding basal cell carcinoma) receiving general practitioner palliative care in the last phase of life. Median age 77 (ATT users) and 73 (nonusers), 40.6% female (ATT users) and 50.8% female (nonusers). Based in the Netherlands.

Intervention

Antithrombotic therapy (ATT) use at index date, including platelet inhibitors, direct oral anticoagulants, vitamin K antagonists, and heparin.

Comparator

No antithrombotic therapy (ATT nonusers) at index date.

Outcome

Incidences of ATT discontinuation, bleeding events, venous thromboembolic (VTE) events, and arterial thromboembolic (ATE) events during follow-up until death.hard clinical

In cancer patients receiving palliative care, bleeding events significantly outnumber thromboembolic events regardless of antithrombotic therapy use, suggesting a need to proactively reconsider ATT in the last phase of life.

Main Result

Absolute Event Rate: 28.5% vs 22%

Limitations

Outcome incidences, especially thromboembolic events, were likely underestimated due to reliance on general practitioner documentation in medical files.
High incidences of loss to follow-up as patients moved to hospice.

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.

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