Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study
Essentials Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients. We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients). At three months, the cumulative incidence of clinically relevant bleeding was 9.8%. Cancer, recent bleeding,...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2017-03, Vol.15 (3), p.420-428 |
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| creator | Tardy, B. Picard, S. Guirimand, F. Chapelle, C. Danel Delerue, M. Celarier, T. Ciais, J.‐F. Vassal, P. Salas, S. Filbet, M. Gomas, J.‐M. Guillot, A. Gaultier, J.‐B. Merah, A. Richard, A. Laporte, S. Bertoletti, L. |
| description | Essentials
Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients.
We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients).
At three months, the cumulative incidence of clinically relevant bleeding was 9.8%.
Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.
Summary
Background
The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown.
Objectives
Our primary aim was to assess the bleeding risk of patients in a real‐world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding.
Patients/Methods
In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non‐major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis.
Results
The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3–11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2–1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months.
Conclusions
Decisions regarding the use of thromboprophylaxis in palliative care patients should take into account the high risk of bleeding in these patients. |
| doi_str_mv | 10.1111/jth.13606 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1854614425</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1854614425</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4546-9e991ddd08ff37e6018a890853b794b798d09ee60c869d8b17086409f1284eb13</originalsourceid><addsrcrecordid>eNp1kE1LAzEQhoMoVqsH_4AEvOihbdLsR-JNS7VKoaD1HLabWZua7tYkq6y_3tS2HgQHhhlmHt5hXoTOKOnSEL2Fn3cpS0iyh45ozHgn5SzZ3_WCsRY6dm5BCBVxnxyiVp8TFqcxOULy1gAoXb5iq90brgrswS51mRnTYG0MXmVeQ-kdnldupX1m9BcorMuwMEaH5QfgPLOA61J7d439HPDTaPg8wc7XqjlBB0VmHJxuaxu93A2ng1FnPLl_GNyMO3kUR0lHgBBUKUV4UbAUEkJ5xgXhMZulIgrJFREQ5jlPhOIzmhKeREQUtM8jmFHWRpcb3ZWt3mtwXi61y8GYrISqdpLycIZGUT8O6MUfdFHVNny8plLGCKMkCdTVhspt5ZyFQq6sXma2kZTItesyuC5_XA_s-Vaxni1B_ZI7mwPQ2wCf2kDzv5J8nI42kt8sRoo6</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1873303106</pqid></control><display><type>article</type><title>Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Tardy, B. ; Picard, S. ; Guirimand, F. ; Chapelle, C. ; Danel Delerue, M. ; Celarier, T. ; Ciais, J.‐F. ; Vassal, P. ; Salas, S. ; Filbet, M. ; Gomas, J.‐M. ; Guillot, A. ; Gaultier, J.‐B. ; Merah, A. ; Richard, A. ; Laporte, S. ; Bertoletti, L.</creator><creatorcontrib>Tardy, B. ; Picard, S. ; Guirimand, F. ; Chapelle, C. ; Danel Delerue, M. ; Celarier, T. ; Ciais, J.‐F. ; Vassal, P. ; Salas, S. ; Filbet, M. ; Gomas, J.‐M. ; Guillot, A. ; Gaultier, J.‐B. ; Merah, A. ; Richard, A. ; Laporte, S. ; Bertoletti, L.</creatorcontrib><description>Essentials
Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients.
We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients).
At three months, the cumulative incidence of clinically relevant bleeding was 9.8%.
Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.
Summary
Background
The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown.
Objectives
Our primary aim was to assess the bleeding risk of patients in a real‐world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding.
Patients/Methods
In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non‐major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis.
Results
The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3–11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2–1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months.
Conclusions
Decisions regarding the use of thromboprophylaxis in palliative care patients should take into account the high risk of bleeding in these patients.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/jth.13606</identifier><identifier>PMID: 28035750</identifier><language>eng</language><publisher>England: Elsevier Limited</publisher><subject>Aged ; Anticoagulants - therapeutic use ; bleeding ; Cancer ; Female ; France ; Hemorrhage ; Heparin, Low-Molecular-Weight - therapeutic use ; Hospice care ; Hospitalization ; Humans ; Incidence ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasms - complications ; Neoplasms - pathology ; Neoplasms - therapy ; observational study ; Palliative Care ; Platelet Aggregation Inhibitors - chemistry ; Platelet Aggregation Inhibitors - therapeutic use ; prophylaxis ; Prospective Studies ; Risk Factors ; Severity of Illness Index ; Terminally Ill ; Thrombosis ; Treatment Outcome ; venous thromboembolism ; Venous Thrombosis - complications ; Venous Thrombosis - prevention & control</subject><ispartof>Journal of thrombosis and haemostasis, 2017-03, Vol.15 (3), p.420-428</ispartof><rights>2016 International Society on Thrombosis and Haemostasis</rights><rights>2016 International Society on Thrombosis and Haemostasis.</rights><rights>Copyright © 2017 International Society on Thrombosis and Haemostasis</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4546-9e991ddd08ff37e6018a890853b794b798d09ee60c869d8b17086409f1284eb13</citedby><cites>FETCH-LOGICAL-c4546-9e991ddd08ff37e6018a890853b794b798d09ee60c869d8b17086409f1284eb13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28035750$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tardy, B.</creatorcontrib><creatorcontrib>Picard, S.</creatorcontrib><creatorcontrib>Guirimand, F.</creatorcontrib><creatorcontrib>Chapelle, C.</creatorcontrib><creatorcontrib>Danel Delerue, M.</creatorcontrib><creatorcontrib>Celarier, T.</creatorcontrib><creatorcontrib>Ciais, J.‐F.</creatorcontrib><creatorcontrib>Vassal, P.</creatorcontrib><creatorcontrib>Salas, S.</creatorcontrib><creatorcontrib>Filbet, M.</creatorcontrib><creatorcontrib>Gomas, J.‐M.</creatorcontrib><creatorcontrib>Guillot, A.</creatorcontrib><creatorcontrib>Gaultier, J.‐B.</creatorcontrib><creatorcontrib>Merah, A.</creatorcontrib><creatorcontrib>Richard, A.</creatorcontrib><creatorcontrib>Laporte, S.</creatorcontrib><creatorcontrib>Bertoletti, L.</creatorcontrib><title>Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study</title><title>Journal of thrombosis and haemostasis</title><addtitle>J Thromb Haemost</addtitle><description>Essentials
Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients.
We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients).
At three months, the cumulative incidence of clinically relevant bleeding was 9.8%.
Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.
Summary
Background
The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown.
Objectives
Our primary aim was to assess the bleeding risk of patients in a real‐world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding.
Patients/Methods
In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non‐major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis.
Results
The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3–11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2–1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months.
Conclusions
Decisions regarding the use of thromboprophylaxis in palliative care patients should take into account the high risk of bleeding in these patients.</description><subject>Aged</subject><subject>Anticoagulants - therapeutic use</subject><subject>bleeding</subject><subject>Cancer</subject><subject>Female</subject><subject>France</subject><subject>Hemorrhage</subject><subject>Heparin, Low-Molecular-Weight - therapeutic use</subject><subject>Hospice care</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasms - complications</subject><subject>Neoplasms - pathology</subject><subject>Neoplasms - therapy</subject><subject>observational study</subject><subject>Palliative Care</subject><subject>Platelet Aggregation Inhibitors - chemistry</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>prophylaxis</subject><subject>Prospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Terminally Ill</subject><subject>Thrombosis</subject><subject>Treatment Outcome</subject><subject>venous thromboembolism</subject><subject>Venous Thrombosis - complications</subject><subject>Venous Thrombosis - prevention & control</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LAzEQhoMoVqsH_4AEvOihbdLsR-JNS7VKoaD1HLabWZua7tYkq6y_3tS2HgQHhhlmHt5hXoTOKOnSEL2Fn3cpS0iyh45ozHgn5SzZ3_WCsRY6dm5BCBVxnxyiVp8TFqcxOULy1gAoXb5iq90brgrswS51mRnTYG0MXmVeQ-kdnldupX1m9BcorMuwMEaH5QfgPLOA61J7d439HPDTaPg8wc7XqjlBB0VmHJxuaxu93A2ng1FnPLl_GNyMO3kUR0lHgBBUKUV4UbAUEkJ5xgXhMZulIgrJFREQ5jlPhOIzmhKeREQUtM8jmFHWRpcb3ZWt3mtwXi61y8GYrISqdpLycIZGUT8O6MUfdFHVNny8plLGCKMkCdTVhspt5ZyFQq6sXma2kZTItesyuC5_XA_s-Vaxni1B_ZI7mwPQ2wCf2kDzv5J8nI42kt8sRoo6</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Tardy, B.</creator><creator>Picard, S.</creator><creator>Guirimand, F.</creator><creator>Chapelle, C.</creator><creator>Danel Delerue, M.</creator><creator>Celarier, T.</creator><creator>Ciais, J.‐F.</creator><creator>Vassal, P.</creator><creator>Salas, S.</creator><creator>Filbet, M.</creator><creator>Gomas, J.‐M.</creator><creator>Guillot, A.</creator><creator>Gaultier, J.‐B.</creator><creator>Merah, A.</creator><creator>Richard, A.</creator><creator>Laporte, S.</creator><creator>Bertoletti, L.</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201703</creationdate><title>Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study</title><author>Tardy, B. ; Picard, S. ; Guirimand, F. ; Chapelle, C. ; Danel Delerue, M. ; Celarier, T. ; Ciais, J.‐F. ; Vassal, P. ; Salas, S. ; Filbet, M. ; Gomas, J.‐M. ; Guillot, A. ; Gaultier, J.‐B. ; Merah, A. ; Richard, A. ; Laporte, S. ; Bertoletti, L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4546-9e991ddd08ff37e6018a890853b794b798d09ee60c869d8b17086409f1284eb13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Anticoagulants - therapeutic use</topic><topic>bleeding</topic><topic>Cancer</topic><topic>Female</topic><topic>France</topic><topic>Hemorrhage</topic><topic>Heparin, Low-Molecular-Weight - therapeutic use</topic><topic>Hospice care</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasms - complications</topic><topic>Neoplasms - pathology</topic><topic>Neoplasms - therapy</topic><topic>observational study</topic><topic>Palliative Care</topic><topic>Platelet Aggregation Inhibitors - chemistry</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>prophylaxis</topic><topic>Prospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Terminally Ill</topic><topic>Thrombosis</topic><topic>Treatment Outcome</topic><topic>venous thromboembolism</topic><topic>Venous Thrombosis - complications</topic><topic>Venous Thrombosis - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tardy, B.</creatorcontrib><creatorcontrib>Picard, S.</creatorcontrib><creatorcontrib>Guirimand, F.</creatorcontrib><creatorcontrib>Chapelle, C.</creatorcontrib><creatorcontrib>Danel Delerue, M.</creatorcontrib><creatorcontrib>Celarier, T.</creatorcontrib><creatorcontrib>Ciais, J.‐F.</creatorcontrib><creatorcontrib>Vassal, P.</creatorcontrib><creatorcontrib>Salas, S.</creatorcontrib><creatorcontrib>Filbet, M.</creatorcontrib><creatorcontrib>Gomas, J.‐M.</creatorcontrib><creatorcontrib>Guillot, A.</creatorcontrib><creatorcontrib>Gaultier, J.‐B.</creatorcontrib><creatorcontrib>Merah, A.</creatorcontrib><creatorcontrib>Richard, A.</creatorcontrib><creatorcontrib>Laporte, S.</creatorcontrib><creatorcontrib>Bertoletti, L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tardy, B.</au><au>Picard, S.</au><au>Guirimand, F.</au><au>Chapelle, C.</au><au>Danel Delerue, M.</au><au>Celarier, T.</au><au>Ciais, J.‐F.</au><au>Vassal, P.</au><au>Salas, S.</au><au>Filbet, M.</au><au>Gomas, J.‐M.</au><au>Guillot, A.</au><au>Gaultier, J.‐B.</au><au>Merah, A.</au><au>Richard, A.</au><au>Laporte, S.</au><au>Bertoletti, L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><addtitle>J Thromb Haemost</addtitle><date>2017-03</date><risdate>2017</risdate><volume>15</volume><issue>3</issue><spage>420</spage><epage>428</epage><pages>420-428</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Essentials
Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients.
We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients).
At three months, the cumulative incidence of clinically relevant bleeding was 9.8%.
Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.
Summary
Background
The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown.
Objectives
Our primary aim was to assess the bleeding risk of patients in a real‐world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding.
Patients/Methods
In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non‐major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis.
Results
The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3–11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2–1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months.
Conclusions
Decisions regarding the use of thromboprophylaxis in palliative care patients should take into account the high risk of bleeding in these patients.</abstract><cop>England</cop><pub>Elsevier Limited</pub><pmid>28035750</pmid><doi>10.1111/jth.13606</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of thrombosis and haemostasis, 2017-03, Vol.15 (3), p.420-428 |
| issn | 1538-7933 1538-7836 1538-7836 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Anticoagulants - therapeutic use bleeding Cancer Female France Hemorrhage Heparin, Low-Molecular-Weight - therapeutic use Hospice care Hospitalization Humans Incidence Kaplan-Meier Estimate Male Middle Aged Neoplasms - complications Neoplasms - pathology Neoplasms - therapy observational study Palliative Care Platelet Aggregation Inhibitors - chemistry Platelet Aggregation Inhibitors - therapeutic use prophylaxis Prospective Studies Risk Factors Severity of Illness Index Terminally Ill Thrombosis Treatment Outcome venous thromboembolism Venous Thrombosis - complications Venous Thrombosis - prevention & control |
| title | Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study |
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