Patient Preference Phenotypes for Post-operative Anticoagulation After Hip or Knee Replacement: A Cross-sectional...

Area of Science:

• Orthopedic Surgery
• Pharmacology
• Health Economics

Background:

• Anticoagulation is crucial post-hip or knee replacement to prevent thrombosis-related events like pulmonary embolism.
• The Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER) trial evaluates optimal anticoagulant strategies (aspirin, warfarin, rivaroxaban).
• Patient preferences significantly influence treatment adherence and outcomes, necessitating their consideration in therapy selection.

Purpose of the Study:

• To investigate the role of patient preferences in tailoring anticoagulant therapy after hip and knee replacement surgery.
• To identify distinct patient subgroups or preference phenotypes based on their valuation of anticoagulant risks and benefits.
• To inform individualized therapeutic approaches within the PEPPER trial and clinical practice.

Main Methods:

• A multimedia conjoint analysis (CA) survey was developed, incorporating expected probabilities of anticoagulant benefits and adverse effects.
• 192 post-hip and post-knee replacement patients eligible for the PEPPER trial were recruited and surveyed 1-7 months post-surgery.
• K-means clustering was employed to analyze patient data and characterize heterogeneity in preferences.

Main Results:

• Patients generally prioritized avoiding pulmonary embolism risk, followed by bleeding and venous thrombosis risks, though individual values varied significantly.
• Three distinct preference phenotypes were identified: thrombosis-focused (aligning with rivaroxaban), balanced (aligning with aspirin), and out-of-pocket cost-focused (aligning with aspirin or warfarin).
• These preference phenotypes showed minimal overlap, indicating clear distinctions in patient priorities regarding anticoagulation therapy.

Conclusions:

• Patient preferences for anticoagulation therapy differ significantly in the post-hip and post-knee replacement population.
• Conjoint analysis revealed three distinct preference phenotypes with implications for personalizing anticoagulant selection.
• Incorporating patient preferences can optimize anticoagulation strategies, potentially improving outcomes and adherence in joint replacement surgery patients.