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Quality of vitamin K antagonist treatment during the last year of life

Chantal Visser Orcid Logo, Eva K. Kempers Orcid Logo, Jamilla Goedgebuur, Denise Abbel, Sarah Aldridge Orcid Logo, Adrian Edwards, Michelle Edwards, Geert‐Jan Geersing, Anne Gulbech Ording, Sjef J. C. M. van de Leur, Kate J. Lifford, Isabelle Mahé, Simon P. Mooijaart, Melchior C. Nierman, Johanneke E. A. Portielje, Mette Søgaard, Sebastian Szmit, Nynke M. Wiersma, Simon I. R. Noble, Frederikus A. Klok, Qingui Chen, Suzanne C. Cannegieter, Eric C. T. Geijteman, Marieke J. H. A. Kruip Orcid Logo, (SERENITY Consortium)

HemaSphere, Volume: 9, Issue: 5, Start page: e70135

Swansea University Author: Sarah Aldridge Orcid Logo

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DOI (Published version): 10.1002/hem3.70135

Abstract

Limited data exist on the quality of anticoagulation in patients approaching the end of life. This study evaluated vitamin K antagonist (VKA) anticoagulation control during the last year of life, using nationwide data from Statistics Netherlands, linked to anticoagulation clinics' data and the...

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Published in: HemaSphere
ISSN: 2572-9241 2572-9241
Published: Wiley 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa69542
Abstract: Limited data exist on the quality of anticoagulation in patients approaching the end of life. This study evaluated vitamin K antagonist (VKA) anticoagulation control during the last year of life, using nationwide data from Statistics Netherlands, linked to anticoagulation clinics' data and the Netherlands Cancer Registry. We included prevalent VKA users who were hospitalized with a severe medical condition and died between January 1, 2013, and December 31, 2019. Anticoagulation control was assessed using time in therapeutic range (TTR), time above therapeutic range (TAR), and time below therapeutic range (TBR) and the international normalized ratio (INR) variance growth rate (VGR), which reflects INR variability. Anticoagulation control was examined by two approaches: (1) over four intervals (0–12 months, 0–9 months, 0–6 months, and 0–3 months preceding death), and (2) in 3‐month intervals (9–12, 6–9, 3–6, and 0–3 months before death) to describe temporal changes. Among 6874 VKA users in their last year of life (median age 82 [Interquartile range: 76–87] years, 46.9% female), the most prevalent severe medical conditions were heart disease (60.4%), cancer (16.2%), and hip fracture (15.2%). As death approached, TTR and TBR decreased, while TAR and mean VGR increased, particularly in the last 3 months of life. This decline was more pronounced in cancer patients and acenocoumarol users. In conclusion, the quality of VKA anticoagulation declined in the last year of life in severely ill patients, marked by reduced TTR and increased TAR and VGR, suggesting an increased bleeding risk. These findings highlight the importance of reassessing VKA use and considering discontinuation in patients approaching the end of life.
College: Faculty of Medicine, Health and Life Sciences
Funders: This project has received funding from the European Union's Horizon Europe Research and Innovation Action under grant agreement no. 101057292. Additionally, UK Research and Innovation (UKRI) has provided funding under the UK government's Horizon Europe funding guarantee (grant agreement no. 10039823 for Cardiff University and 10038000 for Hull York Medical School).
Issue: 5
Start Page: e70135

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