Simon Mooijaart: When Is the Right Time to Stop Antithrombotics at the End of Life?
Simon Mooijaart, Chair of Gerontology and Geriatrics at Leiden University Medical Center, posted on LinkedIn about a recent article his and his colleagues co-authored, published in Thrombosis Research, adding:
“Stopping a drug is often harder than starting it.
Using anti-thrombotic therapy in the last stages both increases bleeding risk on the short term and reduces risk of thrombo-embolic events on the longer term. The question is: what is the right time to stop?
In the clinic: that question exposes a tension: inertia vs responsibility. Continuing feels like the ‘safe’ default. Stopping feels like a decision I can be held accountable for if something goes wrong.
The result: we risk patients carrying bleeding risk and pill burden by default, sometimes up to the last days of life. And we risk turning ‘shared decision-making’ into something that feels like ‘you decide’—without enough support.
The good news is we can support patients better by structuring the conversation: when to revisit antithrombotics, who leads, and how we reassess.
That’s what I value about the European SERENITY collaboration. Just published a two-round Delphi with 188 experts across 8 countries, shaped by a multidisciplinary steering group, spearheaded by Isabelle Mahé.
The results succeeded in shaping the content of the future Shared Decision Support Tool and mapping its useability in palliative care clinical pathways across Europe, with the perspective to support informed decision-making, reduce complications, and improve quality of life in this population.
So: let’s make continuation an active choice. Are you joining us?”
Title: Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study
Authors: Isabelle Mahé, Skerdi Haviari, Nassima Si Mohammed, Anette Arbjerg Højeng, Carme Fonth, Stavros Konstantinides, Marieke J H A Kruip, Luigi Maiorana, Sebastian Szmit, Denise Abbell, Laurent Bertoletti, Adrian Edwards, Michelle Edwards, Alessandra Gaval, Jacobijn Gussekloo, Miriam J Johnson, Rashmi Kumar, Johan Langendoen, Kate J Lifford, Simon Mooijaart, Mark Pearson, Johanneke Portielje, Kathy Seddon, Stella Trompet, Hélène Helfer, Frederikus A Klok, Simon Noble, Camille Couffignale for the DELPHI Serenity Group
Read the Full Article on Thrombosis Research.
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