457P - Anticoagulation for terminal cancer patients with cancer associated venous thromboembolism

Background

Cancer patients have a significantly higher risk of developing venous thromboembolism (VTE) compared to the general population. But there are no data on the management of cancer associated VTE at the end of life and no guidance when to stop anticoagulation for the imminent death in hospice care.

Methods

We retrospectively reviewed 153 VTE patients with advanced cancer who were treated with anticoagulation in our hospital from January 2016 to December 2022.

Results

Total 153 patients managed with anticoagulation for the treatment and secondary prevention for cancer associated VTE were enrolled. The median age of patients with 66 years and 69% of patients were female. The median duration of treatment with anticoagulation was 92.3 days. 42% of patients were receiving prophylactic anticoagulation, most frequently low molecular weight heparin. Of these patients, 47 patients continued anticoagulation therapy until death, 22 patients up to 7 days prior to death, 14 patients up to 28 days to 8 days and 15 patients over 1 month. Clinically relevant non-major bleeding was recorded 8 patients. However, bleeding rates increased closer impending death with 6 patients of bleeding in the last 7 days of life. No data were recorded suggestive of recurrence VTE or major bleeding. Despite specialized palliative consultation, at the time of death 30% of patients were still on prophylactic anticoagulation.

Conclusions

The majority of advanced cancer patients with VTE were managed with anticoagulation up to or within days of death in real world. Patients with poor performance status and short prognosis are unlikely to benefit from anticoagulation. Given the absence of guidelines about the use of anticoagulation in terminal cancer patients, it should be an early and multidisciplinary decision. It will be a strategy to improve a rational policy of anticoagulation and to prevent bleeding complication.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The author.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.