Discontinuing Aspirin in Hospice Patients with History of Stroke
Aspirin should be discontinued in hospice patients with a history of stroke as the focus shifts to comfort care and symptom management rather than long-term prevention of vascular events.
Rationale for Discontinuation
The decision to discontinue aspirin in hospice patients is supported by several key guidelines:
The American College of Cardiology/American Heart Association Task Force specifically lists "patients who are on comfort care measures only or hospice" as a denominator exclusion for aspirin therapy after myocardial infarction 1. This indicates that aspirin is not considered necessary for patients receiving end-of-life care.
Hospice care focuses on quality of life and symptom management rather than preventive therapies aimed at long-term outcomes. Continuing medications that do not contribute to symptom relief is generally not recommended in hospice settings.
Benefits of Discontinuation
Discontinuing aspirin in hospice patients offers several benefits:
Reduced pill burden: Eliminating unnecessary medications decreases the burden on patients who may have difficulty swallowing or who experience medication fatigue.
Decreased risk of adverse effects: Aspirin carries risks of gastrointestinal bleeding and other side effects that may negatively impact quality of life without providing meaningful benefit in the hospice setting.
Focus on comfort: Removing preventive medications allows the care team to focus exclusively on medications that directly improve symptoms and comfort.
Special Considerations
While the general recommendation is to discontinue aspirin in hospice patients, there are a few situations where continuation might be considered:
Recent acute coronary syndrome or stent placement: If the patient has had a very recent cardiac event or stent placement (within 30 days), a brief continuation of aspirin might be considered, but this should be reassessed frequently as the patient's condition changes.
Symptom management: In rare cases where aspirin is being used for pain management or other symptomatic relief rather than stroke prevention, continuation may be appropriate.
Implementation Approach
When discontinuing aspirin:
- Explain the rationale to the patient and family, emphasizing that the focus is shifting to comfort rather than prevention
- Monitor for any withdrawal symptoms (though these are unlikely with aspirin)
- Document the decision and rationale in the medical record
- Ensure the focus remains on appropriate symptom management medications
Conclusion
The evidence clearly supports discontinuing aspirin in hospice patients with a history of stroke. This approach aligns with the goals of hospice care, which prioritize comfort and quality of life over prevention of future events. By discontinuing aspirin, clinicians can reduce medication burden and potential side effects while maintaining focus on interventions that directly improve patient comfort and quality of life.