Deprescribing Antiplatelet and Anticoagulant Medications

Background

Many patients enter hospice already taking antiplatelet or anticoagulant medications, often for cardiovascular disease, atrial fibrillation, or prior blood clots. Studies show that nearly 7% of hospice patients are on these therapies— with more than 18% on multiple antithrombotics¹.

While these medications can reduce the risk of heart attack, stroke, or clot formation, their benefits often decrease as illness progresses, while risks—including bleeding and medication burden—rise. In hospice, where the focus is on comfort and quality of life, continuing these drugs may not always align with patient and family goals of care.

When to Consider Deprescribing

Deprescribing decisions should be individualized and involve shared decision-making with the patient and family. Consider stopping or adjusting therapy if any of the following apply:

• High bleeding risk: Older age, liver/kidney disease, history of GI bleed, or use of multiple blood-thinning drugs².
• Falls: Increased risk of intracranial hemorrhage may outweigh preventive benefits³.
• Declining kidney/liver function or nutrition: Alters drug metabolism and increases bleeding risk⁴,⁵.
• Medication no longer indicated: Many antithrombotic regimens are only beneficial for 3–12 months post-event⁶.
• Difficulty swallowing or pill burden: Complex regimens, frequent INR checks, or inability to take medications safely.
• Goals of care shift: When the focus is comfort, not long-term prevention.

Supporting Patients & Families

• Acknowledge family and patient concerns about new medication changes.
• Explain to patients that as they age, or progress in their disease, the risk of certain medications may outweigh the benefits.
• In some situations, switching to an alternative medication may be safer and possibly as  effective⁷.

Sample Conversation Starter: “Since your mother has fallen several times and isn’t eating much, her blood thinner may now pose more risks than benefits. We’d like to discuss whether stopping it would help keep her safer and more comfortable.”

How to Deprescribe

• Once the decision has been made to discontinue the medication, it can be stopped without a taper.
• If there is still hesitation from the patient or family, a discontinuation trial can be considered for a short period of time (2 weeks), with the potential to re-evaluate after the trial has been completed.

Key Takeaways

• The risks of antithrombotic medications often outweigh the benefits in the hospice patient population.
• Deprescribing does not require tapering—medications can usually be stopped directly.
• Consider a trial discontinuation (e.g., 2–4 weeks) to help families adjust.
• Some patients may still benefit (e.g., symptomatic DVT, recent heart event). Reassess regularly.

Final Note

Deprescribing antiplatelet and anticoagulant medications is a thoughtful, patient-centered decision. By weighing risks and benefits, and engaging families in shared decision-making, hospice teams can ensure care remains focused on comfort, dignity, and quality of life.

Our customers have access to a dedicated 24/7 clinical support line for medication management questions. If you’re unsure whether a discontinuation is appropriate for a patient, our hospice-trained pharmacists are here to help.

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