From the Research
Yes, it is generally appropriate to suspend enoxaparin (low molecular weight heparin) in patients receiving end-of-life care. When a patient enters the terminal phase of illness, the goals of care typically shift from preventive or curative treatments to comfort measures. Enoxaparin, which is primarily used to prevent or treat blood clots, often provides little benefit at this stage while potentially causing discomfort through daily injections. The medication may also contribute to bruising or bleeding, especially as organ function declines.
The decision to discontinue enoxaparin should be made as part of a comprehensive review of all medications, weighing the limited potential benefits against the burden of continued treatment. This decision should involve discussions with the patient (if possible) and family members about goals of care, and should align with advance directives. If the patient has an acute thrombosis that is causing significant symptoms like pain or shortness of breath, continuing anticoagulation at a reduced dose might be considered for symptom management, but in most end-of-life scenarios, discontinuing enoxaparin is consistent with prioritizing comfort and dignity.
Some studies have highlighted the risks associated with anticoagulant therapy, including an increased risk of bleeding when combined with other medications like NSAIDs or aspirin 1. However, in the context of end-of-life care, the focus is on alleviating suffering and improving quality of life rather than preventing potential complications.
It's also worth noting that the use of anticoagulants in end-of-life care is not universally agreed upon, and different guidelines may offer varying recommendations. Nevertheless, the most recent and highest quality studies suggest that suspending enoxaparin in patients receiving end-of-life care is a reasonable approach, as it prioritizes the patient's comfort and dignity over potential, but often minimal, benefits of continued anticoagulation 2.
Key considerations in making this decision include:
- The patient's overall prognosis and goals of care
- The potential benefits and burdens of continued enoxaparin therapy
- The presence of any symptoms that might be alleviated by continued anticoagulation
- The patient's and family's preferences and values regarding end-of-life care.
Ultimately, the decision to suspend enoxaparin should be individualized and based on a thorough assessment of the patient's unique circumstances and needs.