Rationalising anticoagulants used for VTE treatment in palliative care

Follow the principles of rationalising anticoagulants when rationalising anticoagulants in palliative care.

The decision to stop or reduce the dose of an anticoagulant used for VTE treatment in patients with palliative care needs should balance the patient’s risk of bleeding with the risk of recurrent thromboembolism, and consider the impact of associated symptoms. Some patients with deep vein thrombosis (DVT) consider bleeding more distressing than recurrent thromboembolismNoble, 2020. Whereas some patients with ongoing symptoms (eg breathlessness after pulmonary embolism) may prefer to continue the anticoagulant. For information on duration of anticoagulant treatment, dose reduction and common factors predicting recurrence of venous thromboembolism, see Duration of anticoagulant therapy for VTE in the Cardiovascular guidelines.

It is reasonable to stop an anticoagulant used for VTE treatment in the last weeks of life to reduce bleeding risk. Symptomatic VTE takes more than a week to develop after stopping therapy, and if thromboembolism occurs at this time, symptomatic drug therapy can be used to manage associated pain or breathlessness.