Key result
Continuing LMWH near death in advanced cancer yields a 7% bleeding rate without symptom benefit.
Why the study?
There are no data on the management of cancer-associated thrombosis at the end of life or when to stop anticoagulation as death approaches in patients with advanced cancer.
Does continuing anticoagulation for VTE until near death in advanced cancer patients confer bleeding risk without preventing VTE symptoms?
Population
214 patients with advanced cancer anticoagulated for VTE who died over a 2-year period
Comparison
Continuation of LMWH until death or within days vs discontinuation earlier prior to death
Design
Retrospective cohort study reviewing hospital, hospice, and community notes
Follow-up
Until death over a 2-year period
Authors
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May support deprescribing LMWH near death in advanced cancer VTE; leaves open optimal duration pending RCTs.
Cohort (n=214)
Does continuing anticoagulation for VTE until near death in advanced cancer patients confer bleeding risk without preventing VTE symptoms?
Continuing anticoagulation for VTE near the end of life in advanced cancer patients appears to increase bleeding risk without providing additional symptomatic benefit.
Noble et al. (2019) conducted a cohort in Cancer-associated thrombosis in advanced cancer (n=214). Continuation of low-molecular-weight heparin (LMWH) until death or up to 7 days prior was evaluated on Clinically relevant non-major bleeding. Continuing low-molecular-weight heparin until near death in patients with advanced cancer and VTE resulted in a 7% rate of clinically relevant non-major bleeding without preventing VTE symptoms.
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