Semin Thromb Hemost 2015; 41(02): 166-177
DOI: 10.1055/s-0035-1546467
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Development of Recommendations to Continue Anticoagulation with One of the Two Types of Oral Anticoagulants Based on the Identification of Patients' Preference

Shabnam Zolfaghari
1  Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany
,
Job Harenberg
1  Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany
,
Lutz Frölich
2  Central Institute for Mental Health, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany
,
Christel Weiss
3  Department of Biometry and Statistics, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany
,
Martin Wehling
1  Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany
,
Philip Wild
4  Center for Thrombosis and Hemostasis, Mainz, Germany
,
Jürgen Prochaska
5  German Center for Cardiovascular Research (DZHK), Mainz, Germany
,
Jan Beyer-Westendorf
6  Division of Angiology, Department of Medicine III, University Hospital Carl Gustav Carus Dresden Center for Vascular Medicine, Dresden, Germany
,
Jürgen Koscielny
7  Institute for Transfusion Medicine, Charité-University Hospital, Berlin, Germany
,
Gregory Y. H. Lip
8  University of Birmingham Centre for Cardiovascular Sciences City Hospital Birmingham, Birmingham, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
19 February 2015 (online)

Abstract

Patients with indication for anticoagulation may prefer treatment with a vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulant (NOAC). A questionnaire may help to identify the preference of patients for one of the two types of oral anticoagulants and to develop a score for the recommendation to continue or to change the anticoagulant. A score was developed using a questionnaire containing biographic data and eight statements on attitudes on anticoagulation and was derived to trigger continuation or change the type of anticoagulant by defining ranges of terms and weighting of the significant statements identified by logistic regression analysis. Participating patients received either anticoagulation with VKA (group 1, n = 690), were transferred from VKA to NOAC (group 2, n = 158), received NOAC de novo (group 3, n = 137) or were transferred from NOAC to VKA (group 4, n = 19). Four statements were significantly (p values between 0.0347 and < 0.0001) associated with recommendations to maintain or to change the type of anticoagulant for patients in groups 1, 2, or 3 with predictive values of c = 0.83 between groups 1 and 2 and c = 0.71 between groups 1 and 3. From the total number of replies to the statements a score of three grades and two strengths (A = strong, B = moderate) was derived for the recommendations. This tool supports recommendations as to continue or to change the presently used type of oral anticoagulant based on the identification of patients' preferences.