Clinical Discussions in Antithrombotic Therapy Management : A Delphi Consensus Panel

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Direct-acting oral anticoagulants (DOACs) are established treatments for non-valvular atrial fibrillation (NVAF) and venous thromboembolism (VTE).
• Clinical trial data for DOACs do not cover all real-world scenarios, leading to uncertainty in specific patient groups.
• Expert consensus is needed to guide DOAC use in complex clinical situations.

Purpose of the Study:

• To establish a consensus among Italian cardiologists on the use of DOACs in NVAF and VTE patients.
• To address 16 key clinical topics where uncertainty exists regarding DOAC application.
• To provide evidence-based guidance for real-world DOAC management.

Main Methods:

• A Delphi Consensus methodology was employed.
• Sixty-two Italian cardiologists participated in the consensus process.
• A 5-point Likert scale was used to assess agreement on 16 predefined topics related to DOAC use, with consensus defined as ≥66% agreement.

Main Results:

• The consensus covered diverse topics including DOAC superiority over VKAs, first-line treatment, cardioversion, switching strategies, and the roles of GPs and anticoagulation centers.
• Specific attention was given to DOAC use in oncological patients, drug interactions, low-dose DOAC safety, and management of frail patients or those with renal impairment.
• Agreement levels on each statement were recorded, indicating areas of strong consensus and potential divergence.

Conclusions:

• The Delphi Consensus provides expert recommendations on various aspects of DOAC use in NVAF and VTE.
• The findings aim to reduce uncertainty and standardize DOAC management in complex real-world clinical scenarios.
• This consensus serves as a valuable resource for clinicians managing patients on DOAC therapy.