Deprescribing in the Home Palliative Setting

Anticoagulant use and associated outcomes in older patients receiving home palliative care: a retrospective cohort study

“…Deprescribing is a core element of palliative and end-of-life care training and practice, with which experienced and specialized palliative care clinicians must be familiar. 4,59 The absence of strong patient-and physician-level predictors for anticoagulant discontinuation and variability in practices among physicians is in keeping with the lack of consensus about whether to continue or discontinue anticoagulants toward the end of life. A recent study showed wide variation in physicians' opinions and uncertainty regarding anticoagulation in such patients.…”

“…Toward the end of life, patients with advanced disease and their clinicians often consider stopping medications that are not contributing to symptom relief or improving quality of life. [1][2][3][4] Homevisiting palliative care physicians care for such patients, who frequently wish to avoid complications from medical interventions and hospital admissions, and prefer to die at home. [5][6][7][8][9] For this reason, the initial home visit involves a comprehensive assessment of the risks and benefits of all medications, including anticoagulants.…”

“…[5][6][7][8][9] For this reason, the initial home visit involves a comprehensive assessment of the risks and benefits of all medications, including anticoagulants. 4 Because older age, cancer and other comorbidities increase the risk of atrial fibrillation and venous thromboembolism, patients receiving palliative care frequently have indications for anticoagulants; decisions about whether to continue or stop these medications are challenging. 10 For most patients, clinical guidelines informed by randomized controlled trials recommend long-term anticoagulation to reduce morbidity and mortality from cardioembolic stroke in patients with atrial fibrillation [11][12][13] and to prevent recurrent events and premature death in patients Methods: Using linked administrative health databases, we conducted a population-based cohort study of patients aged 66 years and older who initiated home palliative care in Ontario from 2010 to 2018.…”