TY - JOUR
T1 - Prevalence and Clinical Intentions of Antithrombotic Therapy on Discharge to Hospice Care
AU - Kowalewska, Christina A.
AU - Noble, Brie N.
AU - Fromme, Erik K.
AU - McPherson, Mary Lynn
AU - Grace, Kristi N.
AU - Furuno, Jon P.
N1 - Publisher Copyright:
© 2017, Mary Ann Liebert, Inc.
PY - 2017/11
Y1 - 2017/11
N2 - 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> = 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 (p < 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.
AB - 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> = 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 (p < 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.
KW - anticoagulation
KW - antithrombotic therapy
KW - care transitions
KW - hospice
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UR - http://www.scopus.com/inward/citedby.url?scp=85032938530&partnerID=8YFLogxK
U2 - 10.1089/jpm.2016.0487
DO - 10.1089/jpm.2016.0487
M3 - Article
C2 - 28581881
AN - SCOPUS:85032938530
SN - 1096-6218
VL - 20
SP - 1225
EP - 1230
JO - Journal of palliative medicine
JF - Journal of palliative medicine
IS - 11
ER -