When do patients prefer a direct oral anticoagulant over a vitamin K antagonist?

摘要

Background: The reasons for patients to change their usual vitamin K antagonist (VKA) treatment to a direct oral anticoagulant (DOAC) are unexplored. Method: A random sample of 200 patients treated with VKAs for the indication of atrial fibrillation from the Thrombosis Service in Amsterdam was selected. A survey, using the treatment trade-off technique, was sent to participants. The trade-off included four scenarios: 1 (no need for laboratory controls); 2 (less bleeding); 3 (less interactions); 4 (more effective). Results: Under scenario 1, 57% of the patients would have made the switch, with a further increase to 65% with scenario 2 (trend value, p = 0.006, 95% CI 1.11-1.85). In addition, in each scenario patients who were less satisfied with their current treatment were more likely to switch to a DOAC compared with satisfied patients. The variables duration of treatment, gender, age and educational level did not affect the preference for a DOAC. Conclusion: Patients considered no requirement for regular laboratory control and a lower risk of bleeding the most important arguments to switch to a DOAC.