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

Area of Science:

• Cardiology
• Pharmacology
• Patient-centered care

Background:

• Limited understanding of patient motivations for switching from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs).
• VKAs require regular laboratory monitoring, increasing patient burden.

Purpose of the Study:

• To explore patient preferences and reasons for switching from VKA to DOAC therapy.
• To identify key factors influencing patient decisions in anticoagulant treatment choices.

Main Methods:

• A survey using the treatment trade-off technique was administered to 200 patients on VKA therapy for atrial fibrillation.
• Four hypothetical scenarios were presented to assess preferences for DOACs: no lab controls, less bleeding, fewer interactions, and increased effectiveness.

Main Results:

• 57% of patients would switch to DOACs if lab monitoring was unnecessary; this increased to 65% with the added benefit of less bleeding.
• Patients dissatisfied with current VKA treatment were more inclined to switch to DOACs.
• Treatment duration, gender, age, and education level did not impact DOAC preference.

Conclusions:

• The primary drivers for patients switching to DOACs are the absence of routine laboratory monitoring and a reduced risk of bleeding.
• Patient satisfaction with current anticoagulant therapy influences the likelihood of switching to DOACs.