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Preferences vary on anticoagulant use for stroke prevention
A recent review published in the Canadian Journal of Cardiology discusses values and preferences among physicians and patients regarding oral anticoagulation therapy.
“Real-world data on patients’ and physicians’ values relating to the use of oral anticoagulant therapy for stroke prevention in patients with nonvalvular [AF] are currently lacking,” the researchers wrote. “We sought to assess the values, preferences and experience of patients receiving [oral anticoagulation] therapy, and of physicians prescribing [oral anticoagulant] therapy.”
Jason G. Andrade, MD, of the Montreal Heart Institute and the University of British Columbia, and colleagues conducted a survey of physicians (n = 178) and patients (n = 266). All patients had nonvalvular AF and had been prescribed oral anticoagulants for stroke prevention.
The national survey of patients and physicians, who were selected randomly, was conducted between May and September 2014. All participants were asked to assess the effect of the various oral anticoagulants’ specific characteristics and determine a medication profile they would prefer from a set of two. Individual qualities were increasingly altered to assess which were most valued and/or affected selection of treatment. Adherence to medication and prescribing practices were also evaluated.
Although preferences about oral anticoagulation therapy varied between patients and physicians, they did focus primarily on factors related to safety and, to a smaller degree, efficacy. Physicians were more likely to choose apixaban (61%; Eliquis, Bristol-Myers Squibb) based entirely on the characteristics of the agent, as they were masked to the agent, but patients showed no preference between apixaban, rivaroxaban (Xarelto, Janssen Pharmaceuticals) and warfarin. However, in contrast to their stated medication of choice, 49% of physicians spontaneously named rivaroxaban as their favored agent vs. 25% for apixaban.
Patients prescribed a once-daily medication (rivaroxaban or warfarin) who took it as instructed were more adherent. About 30% of twice-daily medications were only taken once per day, with “significantly” more missed doses as compared with medications that only needed to be taken once per day.
“Real-world prescriptions do not reflect reported values, suggesting other factors influence patient–physician decision-making around [oral anticoagulant] therapy,” the researchers wrote. “Data on self-reported adherence to [oral anticoagulant] therapy and discordance in the use of [oral anticoagulants] from prescribed regimens are concerning and warrant further investigation.” – by Julia Ernst, MS
Disclosure: Andrade reports receiving consulting fees and honoraria from Bayer, Bristol-Myers Squibb-Pfizer and Boehringer Ingelheim, and research support from Medtronic. Please see the full study for a list of all other authors’ relevant financial disclosures.