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J Palliat Med. 2017 Nov;20(11):1225-1230. doi: 10.1089/jpm.2016.0487. Epub 2017 Jun 5.

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

Author information

1
1 Department of Pharmacy Services, Oregon Health & Science University Hospitals and Clinics , Portland, Oregon.
2
2 Department of Pharmacy Practice, Oregon State University/Oregon Health & Science University College of Pharmacy , Portland, Oregon.
3
3 Palliative Care Service, Oregon Health & Science University Hospitals and Clinics , Portland, Oregon.
4
4 Division of Hematology and Medical Oncology, Knight Cancer Institute, Oregon Health & Science University Hospitals and Clinics , Portland, Oregon.
5
5 Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore, Maryland.
6
6 Department of Care Management, Oregon Health & Science University Hospitals and Clinics , Portland, Oregon.

Abstract

BACKGROUND:

There are no guidelines for antithrombotic therapy on admission to hospice care. Antithrombotic therapy may offer some benefit in these patients, but is also associated with well-described risks.

OBJECTIVE:

We quantified the frequency and characteristics of patients prescribed antithrombotic therapy on discharge from acute care to hospice care.

DESIGN:

Retrospective cohort study. Settings/Subjects: Adult (age>ā€‰=ā€‰21 years) patients discharged from acute care to hospice care between January 1, 2010 and June 30, 2014.

MEASURES:

Our primary outcome of interest was receiving an outpatient prescription for antithrombotic therapy on discharge to hospice care.

RESULTS:

Among 1141 eligible patients, 77 (6.7%) patients received a prescription for antithrombotic therapy on discharge to hospice care, most frequently, aspirin (57.1%), enoxaparin (26.0%), and warfarin (20.8%). Patients actively treated for deep vein thromboembolism or pulmonary embolism, or with a history of atrial fibrillation or aortic/mitral valve replacement were significantly more likely to receive antithrombotic therapy. Patients with a history of cancer, cerebrovascular disease, or liver disease were significantly less likely to receive antithrombotic therapy (pā€‰<ā€‰0.05 for all). Among patients who received antithrombotic therapy, 22% were not receiving antithrombotic therapy before the index admission. Among patients previously receiving antithrombotic therapy, 55% continued on the same medication, of which 54.5% did not have any documented rationale for continuation.

CONCLUSIONS:

Prescriptions for antithrombotic therapy were infrequent and often lacked a documented rationale. Further research is needed on the safety and effectiveness of antithrombotic therapy in hospice care and what drives current medication decisions in the absence of these data.

KEYWORDS:

anticoagulation; antithrombotic therapy; care transitions; hospice

PMID:
28581881
PMCID:
PMC5672614
DOI:
10.1089/jpm.2016.0487
[Indexed for MEDLINE]
Free PMC Article

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