*This recording is repurposed from the 2023 Annual Assembly

Venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolization, occurs in 1 and 1000 adults. Frequencies will likely increase with age, reduced mobility, and concurrent chronic illness such as heart failure or cancer. Research suggests that sudden asymptomatic death is a rare event occurring less than 10% of the time. Autopsy studies indicate that most patients experiencing thrombotic events such as pulmonary embolization have prolonged symptomatic deaths lasting on average of 2 hours dominated by symptoms such as dyspnea, tachycardia, and pain. Atrial Fibrillation affects 9% of persons over the age of 65, and many patients who enroll in hospice are on anticoagulation for AFib. The benefit of anticoagulation is unclear in a hospice population for both prophylaxis for atrial fibrillation and treatment for VTE. Current guidelines for managing venous thromboembolism and AFib do not apply to advanced illnesses. Developing approaches to facilitate decision-making for managing anticoagulation for AFib and thromboembolic disease in hospice patients is the goal of this session. An expert panel of palliative care physicians, hematologists, and pharmacotherapy specialists will present cases, didactic material, and engage the audience with the following goals: 
a. Discuss the mechanisms of action of currently available anticoagulants. 
b. Discuss the quality-of-life benefits associated with using use of anticoagulants in the hospice population.
c. Recognize potential drug interactions between anticoagulants and other prescribed medications at the end of life.
d. Recognize bleeding risk and learn how to manage bleeding associated with using anticoagulants at the end of life. 
e. Discuss communication approaches with patients and family when deprescribing anticoagulants 
f. Determine the optimal anticoagulant based on prognosis.