Prevalence and Factors Associated With Receiving a Prescription for Antithrombotic Therapy on Hospice Admission.

Background: Little is known regarding antithrombotic prescribing in U.S. hospice patients. We quantified the prevalence and predictors of receiving an antithrombotic prescription on hospice admission.

Methods: This was a cross-sectional study using electronic health record data from adult (age ≥ 18 years) decedents of a large, for-profit hospice chain who died between January 1, 2017, and December 31, 2019. Our primary outcome was having a prescription for antithrombotic (anticoagulant or antiplatelet) therapy on hospice admission. We used multivariable logistic regression to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: Among 54,643 hospice decedents, the mean age was 79.7 (standard deviation (SD) 13.2) years, 44.6% were male, and 57.0% were White. The median hospice length of stay was 9 (interquartile range 3-40) days, and 18,531 patients (33.9%) had a Palliative Performance Scale (PPS) score of 30%. Overall, 11,360 patients (20.8%) had at least one antithrombotic prescription on hospice admission. The most frequently prescribed antithrombotic classes were antiplatelets (15.7%) and direct oral anticoagulants (3.7%). Patients with PPS scores of 20%-30% (adjusted OR (aOR) 9.38, 95% CI 8.03-10.95), 40%-50% (aOR 15.69, 95% CI 13.38-18.40), and 60%-100% (aOR 15.67, 95% CI 12.41-19.79) were significantly more likely to receive an antithrombotic prescription compared to patients with a PPS score < 20%. Additionally, patients receiving care in an assisted living facility (aOR 4.34, 95% CI 3.86-4.87), nursing home (aOR 4.02, 95% CI 3.62-4.47), or at home (aOR 4.08, 95% CI 3.74-4.45) were more likely to receive an antithrombotic prescription compared to patients receiving care in an inpatient hospice setting.

Conclusions: Antithrombotic therapy was prevalent on hospice admission and most associated with better patient prognosis and non-inpatient hospice care locations. More research is needed to optimize antithrombotic prescribing in hospice care.