Predictors of anticoagulation in hospice patients with lung cancer

Abstract

BACKGROUND Guidelines recommend lifelong anticoagulation in patients with cancer and a history of thromboembolism, but the use of anticoagulation in hospice has not been described. A retrospective study of medication data was conducted to determine patterns of anticoagulant use and predictors of type of anticoagulant prescribed for hospice patients with lung cancer. METHODS Medication data were evaluated for 16,896 hospice patients with lung cancer in 2006 to determine patient and hospice characteristics that predicted anticoagulant prescription. Independent predictors of warfarin versus low molecular weight heparin (LMWH) prescription were identified using a logistic regression model. RESULTS One of every 11 patients was prescribed an anticoagulant, most commonly warfarin. Compared with patients prescribed LMWH, patients prescribed warfarin were older (71.6 vs 65.8 years, P<.001), were more likely white (81.2% vs 74.3%, P = .03), had a longer stay in hospice (median 21 days vs 17 days, P = .001), and were more likely to have ≥3 comorbid illnesses (37.5% vs 25.0%, P<.001). The strongest independent predictor of type of anticoagulant prescribed was geographic region, with hospices in the Northeast more likely to prescribe LMWH. CONCLUSIONS Anticoagulant use is prevalent in patients with lung cancer enrolled in hospice. This study highlights the need to understand the benefits and risks of anticoagulation at the end of life.

Prevalence and Clinical Intentions of Antithrombotic Therapy on Discharge to Hospice Care

“…Other studies have reported that the prevalence of anticoagulation therapy in hospice ranges from 9% among hospice patients with lung cancer in the United States to 47% of patients across 21 palliative care units in Austria. 14,15 Our observed prevalence of 7% of patients is lower than these previous estimates. This may be due to inclusion of hospice patients with diagnoses not indicating antithrombotic therapy or be due to differences between the U.S. and European hospice systems.…”

Thromboprophylaxis in the End-of-Life Cancer Care: The Update

“…The prevalence of anticoagulation therapy at the end of life setting, both primary and secondary, varies across the institutions and countries. A study by Holmes et al [14] showed that 9% (1557 out of 16,896) of lung cancer patients who were receiving home hospice care were prescribed TPX, although the type of TPX (primary vs. secondary) was not specified. Similar data were reported by Johnson et al [15] in a retrospective study, demonstrating that primary TPX was being received by 6% of patients admitted to hospice in the UK.…”

Non–Vitamin K Antagonist Oral Anticoagulants and Factors Influencing the Ischemic and Bleeding Risk in Elderly Patients With Atrial Fibrillation: A Review of Current Evidence

“… 99 However, there are challenges to using anticoagulants in palliative care, including the risk of discontinuing anticoagulation, the risk of bleeding, which is further increased in patients with renal failure and malnutrition, and potential DDIs. 100 When considering the use of NOACs in end-of-life care, it is essential to make decisions based on each individual case and consider the patient's wishes and those of care givers and family as appropriate. 97…”