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

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.

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).

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.

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.