Predictors of anticoagulation in hospice patients with lung cancer.
BACKGROUND
Guidelines recommend lifelong anticoagulation in patients with cancer and a history of thromboembolism, but the use of anticoagulation in hospice has not been described. A retrospective study of medication data was conducted to determine patterns of anticoagulant use and predictors of type of anticoagulant prescribed for hospice patients with lung cancer.


METHODS
Medication data were evaluated for 16,896 hospice patients with lung cancer in 2006 to determine patient and hospice characteristics that predicted anticoagulant prescription. Independent predictors of warfarin versus low molecular weight heparin (LMWH) prescription were identified using a logistic regression model.


RESULTS
One of every 11 patients was prescribed an anticoagulant, most commonly warfarin. Compared with patients prescribed LMWH, patients prescribed warfarin were older (71.6 vs 65.8 years, P<.001), were more likely white (81.2% vs 74.3%, P = .03), had a longer stay in hospice (median 21 days vs 17 days, P = .001), and were more likely to have ≥3 comorbid illnesses (37.5% vs 25.0%, P<.001). The strongest independent predictor of type of anticoagulant prescribed was geographic region, with hospices in the Northeast more likely to prescribe LMWH.


CONCLUSIONS
Anticoagulant use is prevalent in patients with lung cancer enrolled in hospice. This study highlights the need to understand the benefits and risks of anticoagulation at the end of life.
Holmes
Holly M
HM
Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. hholmes@mdanderson.org
Bain
Kevin T
KT
Zalpour
Ali
A
Luo
Ruili
R
Bruera
Eduardo
E
Goodwin
James S
JS
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D004347:Drug Interactions; D005260:Female; D017051:Hospice Care; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D013923:Thromboembolism / Q000188:drug therapy*
D000925:Anticoagulants