Physician perceptions and use of reduced-dose direct oral anticoagulants for extended phase venous thromboembolism treatment.

Autor: Groat D; Center for Humanizing Critical Care Intermountain Medical Center Murray Utah USA., Martin KA; Division of Hematology/Oncology Department of Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USA., Rosovsky RP; Division of Hematology/Oncology Department of Medicine Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA., Sanfilippo KM; Division of Hematology Department of Medicine Washington University School of Medicine St Louis Missouri USA., Gaddh M; Department of Hematology and Medical Oncology Emory University School of Medicine Atlanta Georgia USA., Kreuziger LB; Blood Research Institute Versiti Milwaukee Wisconsin USA., Eyster ME; Penn State Hershey Medical Center Hershey Pennsylvania USA., Woller SC; Department of Medicine Intermountain Medical Center Murray Utah USA.; Department of Internal Medicine University of Utah School of Medicine Salt Lake City Utah USA.
Jazyk: angličtina
Zdroj: Research and practice in thrombosis and haemostasis [Res Pract Thromb Haemost] 2022 Jun 08; Vol. 6 (4), pp. e12740. Date of Electronic Publication: 2022 Jun 08 (Print Publication: 2022).
DOI: 10.1002/rth2.12740
Abstrakt: Background: The direct oral anticoagulants (DOACs), apixaban and rivaroxaban, have been studied for extended-phase treatment of venous thromboembolism (VTE). Yet, scant evidence exists surrounding clinician practice and decision-making regarding dose reduction.
Aims: Report clinician practice and characteristics surrounding dose reduction of DOACs for extended-phase VTE treatment.
Methods: We conducted a 16-question REDCap survey between July 14, 2021, and September 13, 2021, among ISTH 2021 Congress attendees and on Twitter. We explored factors associated with dose reduction using logistic regression. We used k-means clustering to identify distinct groups of dose-reduction decision-making. Random forest analysis explored demographics with respect to identified groups.
Results: Among 171 respondents, most were attending academic physicians from North America. Clinicians who treated larger volumes of patients had higher odds of dose reduction. We identified five clusters that showed distinct patterns of behavior regarding dose reduction. Cluster 1 rarely dose reduces and likely prescribes rivaroxaban over apixaban; cluster 2 dose reduces frequently, does not consider age when dose-reducing, is least likely to temporarily reescalate dosing, and prescribes apixaban and rivaroxaban equally; cluster 3 dose reduces <50% of the time, and temporarily reescalates dosing during increased VTE risk; cluster 4 dose reduces frequently, temporarily reescalates dosing, and is most likely to prescribe apixaban over rivaroxaban; and cluster 5 dose reduces most frequently, and takes the fewest risk factors into consideration when deciding to dose reduce.
Conclusions: Most clinicians elect to dose-reduce DOACs for extended-phase anticoagulation. The likelihood of a clinician to dose reduce increases with volume of patients treated. Clinician prescribing patterns cluster around VTE risk factors as well as reescalation during high-risk periods.
(© 2022 The Authors. Research and Practice in Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis (ISTH).)
Databáze: MEDLINE
Externí odkaz: