Patients’ preferences for new versus old anticoagulants: a mixed-method vignette-based study

Bajorek, Beata; Saxton, Brooke; Anderson, Elizabeth M.; Chow, Clara K

doi:10.1177/1474515117739618

Cited by 16 publications

(25 citation statements)

References 38 publications

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“…However, the results on patient preferences have been mixed . For example, patients’ attitudes towards monitoring may vary considerably, and some patients using warfarin are reluctant to switch to a DOAC because the lack of laboratory monitoring . This accords with our interviews where physicians mentioned both patients’ negative and positive attitudes towards INR monitoring.…”

Section: Discussionsupporting

confidence: 60%

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Physicians’ views on patient participation in choice of oral anticoagulants in atrial fibrillation—a qualitative study

Aarnio

Huupponen

Hämeen‐Anttila

et al. 2018

Basic Clin Pharma Tox

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Direct oral anticoagulants provide an alternative to vitamin K antagonists for the anticoagulation therapy in atrial fibrillation (AF). The availability of several treatment options with different attributes makes shared decision-making appropriate for the choice of anticoagulation therapy. The aim of this study was to understand how physicians choose an oral anticoagulant (OAC) for patients with AF and how physicians view patients' participation in this decision. Semi-structured interviews with 17 Finnish physicians (eight general practitioners and nine specialists) working in the public sector were conducted. An interview guide on experience, prescribing and opinions about oral anticoagulants was developed based on previous literature. The data were thematically analysed using deductive and inductive approaches. Based on the interviews, patient's opinion was the most influential factor in decision-making when there were no clinical factors limiting the choice between OACs. Of patient's preferences, the most important was the attitude towards co-payments of OACs. Patients' opinions on monitoring of treatment, dosing and antidote availability were also mentioned by the interviewees. The choice of an OAC in AF was patient-centred as all interviewees expressed that patient's opinion affects the choice. K E Y W O R D Satrial fibrillation, direct oral anticoagulants, interview, prescription of drugs, warfarin

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Section: Discussionsupporting

confidence: 60%

“…Patients’ differing preferences reported in previous studies and in our study emphasize the importance of shared decision‐making when choosing an OAC. As different patients have different preferences, physicians should ask their patients which attributes are important to them.…”

Section: Discussionmentioning

confidence: 53%

Physicians’ views on patient participation in choice of oral anticoagulants in atrial fibrillation—a qualitative study

Aarnio

Huupponen

Hämeen‐Anttila

et al. 2018

Basic Clin Pharma Tox

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“…Direct oral anticoagulants (DOACs) are often preferred over warfarin and are being used more frequently in clinical practice due to their predictable response, lack of monitoring required, and fewer food and drug interactions [2][3][4]. However, some patients are unable to use DOACs due to their indication for anticoagulation while some patients prefer warfarin due to the regular contact with health care providers and frequent monitoring [3,[5][6][7]. There is limited evidence available to guide clinicians on an ideal INR follow-up interval for patients with stable warfarin doses.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and safety of a 12-week INR follow-up protocol over 2 years in an anticoagulation clinic: a single-arm prospective cohort study

Porter

Margolis

Staresinic

et al. 2018

J Thromb Thrombolysis

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The 2012 American College of Chest Physicians' guidelines recommended a 12-week INR follow-up interval may be appropriate for patients on stable warfarin doses. Limited evidence supports this recommendation. A single-arm, prospective cohort study over 24 months was completed in a Veterans Affairs anticoagulation clinic to determine the long-term feasibility and safety of implementing an extended INR follow-up interval in Veterans on stable doses of warfarin. Participants were required to have a stable warfarin dose for 6 months prior to enrollment. A prespecified protocol was used to titrate, extend, and manage the INR interval up to 12 weeks. Scheduling of extended INR intervals was a primary outcome. Safety outcomes included major and serious bleeding and thromboembolic events. A post-hoc comparison of baseline characteristics between individuals who were scheduled for at least 4 consecutive 12week INR follow-up intervals and those who were not was completed. Of the 50 participants, 36 (72%) were scheduled for at least one 12-week interval and 15 (30%) were scheduled for 4 consecutive intervals. There were 2 thromboembolic events that occurred in 1 participant. There were 28 major and serious bleeding events in 19 participants; 8 occurred while on the extended

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“…7 A qualitative meta-synthesis study of patient and provider perceptions of anticoagulation concluded that the patient experience is not well understood by providers. 8 While some studies found patients’ preferred DOACs because they were easy to take and did not require testing, 9 – 11 other patients favored warfarin explicitly because they were reassured by ongoing laboratory monitoring. 12 Warfarin was also sometimes preferred by patients because, unlike DOACs, warfarin has an antidote in the event of a bleeding complication.…”

Section: Introductionmentioning

confidence: 99%

“…12 Warfarin was also sometimes preferred by patients because, unlike DOACs, warfarin has an antidote in the event of a bleeding complication. 3 , 13 Considerable variation in patient preferences is seen in studies using a variety of methodological approaches, including surveys of patient experience, 14 economic preference analysis of willingness to pay for DOAC instead of warfarin, 15 a vignette-based questionnaire, 11 a treatment trade-off evaluation, 12 and open-ended patient interviews. 11 This contrasts with more consistent clinician proclivity toward DOACs.…”

Section: Introductionmentioning

confidence: 99%

<p>Veterans Perceptions of Satisfaction and Convenience with Anticoagulants for Atrial Fibrillation: Warfarin versus Direct Oral Anticoagulants</p>

Mull¹,

Shin²,

Engle³

et al. 2020

PPA

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Background: Atrial fibrillation (AFib) is associated with high morbidity and mortality. Traditionally, AFib was treated with warfarin, yet recent evidence suggests patients may favor direct oral anticoagulants (DOACs). Variation in preferences is common and we explored patients' perceptions of satisfaction and convenience of DOACs versus warfarin within the Veterans Health Administration (VA). Patients and Methods: We administered a cross-sectional survey, the Perception of Anticoagulant Treatment Questionnaire 2 (PACT-Q2), to Veterans residing in New England, age ≥65, diagnosed with AFib, and actively taking anticoagulant medication in fiscal year 2018. Survey recipients were randomly selected among patients on warfarin (n=200) or DOACs (n=200). A selection of survey respondents agreed to a follow-up semistructured interview (n=16) to further investigate perceptions of satisfaction and convenience. Results: Of 400 patients, 187 completed the PACT-Q2 survey (49% on DOACs; 51% on warfarin). DOACs received significantly higher convenience ratings than warfarin (87.6, SD 13.5 vs 81.1, SD 18.8; p=0.007); there was no difference in satisfaction (64.2, SD 20.5 SD, warfarin vs, 67.3, SD 19.4, DOACs). Interview results showed that participants perceived their treatment to be convenient. However, participants expressed challenges related to the convenience of taking warfarin or DOACs, such as warfarin users having to follow dietary recommendations or DOAC users desiring some additional monitoring to answer questions or concerns. Overall, warfarin and DOAC users reported satisfaction with ongoing monitoring methods, although a few DOAC users expressed uncertainties with the frequency of monitoring. For most participants, concerns about side effects did not differ by anticoagulant type nor affect satisfaction. Conclusion: Our survey and interview results showed variable patient satisfaction and perceptions of convenience with both DOACs and warfarin. Although DOACs are increasingly prescribed for AFib, some Veterans felt that regular follow-up on warfarin was advantageous. Our findings demonstrate the importance of patient-centered decisionmaking in AFib treatment in the VA patient population.

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Patients’ preferences for new versus old anticoagulants: a mixed-method vignette-based study

Cited by 16 publications

References 38 publications

Physicians’ views on patient participation in choice of oral anticoagulants in atrial fibrillation—a qualitative study

Physicians’ views on patient participation in choice of oral anticoagulants in atrial fibrillation—a qualitative study

Feasibility and safety of a 12-week INR follow-up protocol over 2 years in an anticoagulation clinic: a single-arm prospective cohort study

<p>Veterans Perceptions of Satisfaction and Convenience with Anticoagulants for Atrial Fibrillation: Warfarin versus Direct Oral Anticoagulants</p>

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