title: Bleeding risk of terminally ill patients hospitalized in palliative care units: the RHESO study.
abstract: Essentials Bleeding incidence as hemorrhagic risk factors are unknown in palliative care inpatients. We conducted a multicenter observational study (22 Palliative Care Units, 1199 patients). At three months, the cumulative incidence of clinically relevant bleeding was 9.8%. Cancer, recent bleeding, thromboprophylaxis and antiplatelet therapy were independent risk factors.
  
  
  
  Background The value of primary thromboprophylaxis in patients admitted to palliative care units is debatable. Moreover, the risk of bleeding in these patients is unknown. Objectives Our primary aim was to assess the bleeding risk of patients in a real-world practice setting of hospital palliative care. Our secondary aim was to determine the incidence of symptomatic deep vein thrombosis and to identify risk factors for bleeding. Patients/Methods In this prospective, observational study in 22 French palliative care units, 1199 patients (median age, 71 years; male, 45.5%), admitted for the first time to a palliative care unit for advanced cancer or pulmonary, cardiac or neurologic disease were included. The primary outcome was adjudicated clinically relevant bleeding (i.e. a composite of major and clinically relevant non-major bleeding) at 3 months. The secondary outcome was symptomatic deep vein thrombosis. Results The most common reason for palliative care was cancer (90.7%). By 3 months, 1087 patients (91.3%) had died and 116 patients had presented at least one episode of clinically relevant bleeding (fatal in 23 patients). Taking into account the competing risk of death, the cumulative incidence of clinically relevant bleeding was 9.8% (95% confidence interval [CI], 8.3-11.6). Deep vein thrombosis occurred in six patients (cumulative incidence, 0.5%; 95% CI, 0.2-1.1). Cancer, recent bleeding, antithrombotic prophylaxis and antiplatelet therapy were independently associated with clinically relevant bleeding at 3 months. Conclusions Decisions regarding the use of thromboprophylaxis in palliative care patients should take into account the high risk of bleeding in these patients.
authors.affiliation: Inserm, CIC 1408, FCRIN-INNOVTE, Saint-Etienne, France.|UMR1059 SAINBIOSE, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France.|Service de Soins Intensifs Médicaux, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: B
authors.initials: B
authors.lastname: Tardy
authors.affiliation: Unité de Soins Palliatifs, Hôpital les Diaconesses, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Picard
authors.affiliation: Pôle Recherche SPES "soins palliatifs en société", Maison Médicale Jeanne Garnier, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Guirimand
authors.affiliation: Inserm, CIC 1408, FCRIN-INNOVTE, Saint-Etienne, France.|UMR1059 SAINBIOSE, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France.
authors.forename: C
authors.initials: C
authors.lastname: Chapelle
authors.affiliation: Unité de Soins Palliatifs, Centre Hospitalier Saint Vincent de Paul, Lille, France.
authors.forename: M
authors.initials: M
authors.lastname: Danel Delerue
authors.affiliation: Fédération de Soins Palliatifs, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: T
authors.initials: T
authors.lastname: Celarier
authors.affiliation: Unité de Soins Palliatifs, Centre Hospitalo-Universitaire de Nice, Nice, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Ciais
authors.affiliation: Fédération de Soins Palliatifs, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: P
authors.initials: P
authors.lastname: Vassal
authors.affiliation: Service d'Oncologie Médicale, Assistance Publique des Hôpitaux de Marseille, Marseille, France.|CRO2, Aix Marseille Université, Marseille, France.|INSERM U911, Marseille, France.
authors.forename: S
authors.initials: S
authors.lastname: Salas
authors.affiliation: Centre de Soins Palliatifs, Centre Hospitalier Lyon Sud, Hospices Civiles de Lyon, Pierre-Bénite, France.
authors.forename: M
authors.initials: M
authors.lastname: Filbet
authors.affiliation: Unité de Soins Palliatifs, Hôpital Sainte Perine, Assistance Publique des Hôpitaux de Paris, Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Gomas
authors.affiliation: Service d'Oncologie Médicale, Institut de Cancérologie Lucien Neuwirth, Saint Priest en Jarez, France.
authors.forename: A
authors.initials: A
authors.lastname: Guillot
authors.affiliation: Service de Médecine Interne, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: J-B
authors.initials: JB
authors.lastname: Gaultier
authors.affiliation: Inserm, CIC 1408, FCRIN-INNOVTE, Saint-Etienne, France.
authors.forename: A
authors.initials: A
authors.lastname: Merah
authors.affiliation: Fédération de Soins Palliatifs, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: A
authors.initials: A
authors.lastname: Richard
authors.affiliation: UMR1059 SAINBIOSE, Université Jean Monnet, PRES de Lyon, Saint-Etienne, France.|Unité de Recherche Clinique, Innovation et Pharmacologie, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: S
authors.initials: S
authors.lastname: Laporte
authors.affiliation: Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne, Saint-Etienne, France.
authors.forename: L
authors.initials: L
authors.lastname: Bertoletti
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005602:France; D006470:Hemorrhage; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D010166:Palliative Care; D010975:Platelet Aggregation Inhibitors / Q000737:chemistry / Q000627:therapeutic use; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D019452:Terminally Ill; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors
keywords: bleeding; observational study; palliative care; prophylaxis; venous thromboembolism