Clinical Discussions in Antithrombotic Therapy Management in Patients With Atrial Fibrillation: A Delphi Consensus...

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Direct-acting oral anticoagulants (DOACs) are increasingly used for stroke prevention in atrial fibrillation and venous thromboembolism.
• Clinical trials have not fully addressed uncertainties regarding DOAC use in real-world patient scenarios.

Purpose of the Study:

• To establish consensus on the use of DOACs in non-valvular atrial fibrillation patients through a Delphi process.
• To address specific clinical uncertainties related to DOAC application in diverse patient populations.

Main Methods:

• A Delphi consensus process involving 101 physicians (cardiologists, internists, geriatricians, hematologists) from Italy.
• Physicians rated agreement on 9 key topics concerning DOAC use using a 5-point Likert scale.
• Consensus was defined as agreement among at least 66% of respondents.

Main Results:

• The study identified areas of uncertainty regarding DOAC application in clinical practice.
• Specific topics included comparisons with vitamin K antagonists, use in elderly and hyperfiltering patients, drug interactions, and management of specific complications like left atrial appendage thrombosis.
• Physician agreement levels varied across the discussed statements.

Conclusions:

• Significant uncertainty persists in the clinical application of DOACs.
• Particular challenges exist in managing elderly, fragile, comorbid, and hyperfiltering patients on DOACs.
• Further guidance and consensus are needed for optimal real-world DOAC utilization.