Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment
Abstract Background The direct oral anticoagulants (DOACs), apixaban and rivaroxaban, have been studied for extended‐phase treatment of venous thromboembolism (VTE). Yet, scant evidence exists surrounding clinician practice and decision‐making regarding dose reduction. Aims Report clinician practice...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-05-01
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| Series: | Research and Practice in Thrombosis and Haemostasis |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/rth2.12740 |
| _version_ | 1797719636156874752 |
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| author | Danielle Groat Karlyn A. Martin Rachel P. Rosovsky Kristen M. Sanfilippo Manila Gaddh Lisa Baumann Kreuziger M. Elaine Eyster Scott C. Woller for the Venous thromboEmbolism Network US (VENUS) VTE Treatment, Anticoagulation Management Group |
| author_facet | Danielle Groat Karlyn A. Martin Rachel P. Rosovsky Kristen M. Sanfilippo Manila Gaddh Lisa Baumann Kreuziger M. Elaine Eyster Scott C. Woller for the Venous thromboEmbolism Network US (VENUS) VTE Treatment, Anticoagulation Management Group |
| author_sort | Danielle Groat |
| collection | DOAJ |
| description | Abstract Background The direct oral anticoagulants (DOACs), apixaban and rivaroxaban, have been studied for extended‐phase treatment of venous thromboembolism (VTE). Yet, scant evidence exists surrounding clinician practice and decision‐making regarding dose reduction. Aims Report clinician practice and characteristics surrounding dose reduction of DOACs for extended‐phase VTE treatment. Methods We conducted a 16‐question REDCap survey between July 14, 2021, and September 13, 2021, among ISTH 2021 Congress attendees and on Twitter. We explored factors associated with dose reduction using logistic regression. We used k‐means clustering to identify distinct groups of dose‐reduction decision‐making. Random forest analysis explored demographics with respect to identified groups. Results Among 171 respondents, most were attending academic physicians from North America. Clinicians who treated larger volumes of patients had higher odds of dose reduction. We identified five clusters that showed distinct patterns of behavior regarding dose reduction. Cluster 1 rarely dose reduces and likely prescribes rivaroxaban over apixaban; cluster 2 dose reduces frequently, does not consider age when dose‐reducing, is least likely to temporarily reescalate dosing, and prescribes apixaban and rivaroxaban equally; cluster 3 dose reduces <50% of the time, and temporarily reescalates dosing during increased VTE risk; cluster 4 dose reduces frequently, temporarily reescalates dosing, and is most likely to prescribe apixaban over rivaroxaban; and cluster 5 dose reduces most frequently, and takes the fewest risk factors into consideration when deciding to dose reduce. Conclusions Most clinicians elect to dose‐reduce DOACs for extended‐phase anticoagulation. The likelihood of a clinician to dose reduce increases with volume of patients treated. Clinician prescribing patterns cluster around VTE risk factors as well as reescalation during high‐risk periods. |
| first_indexed | 2024-03-12T09:08:57Z |
| format | Article |
| id | doaj.art-6b5619582fe34a3b9426fc9ac72adb59 |
| institution | Directory Open Access Journal |
| issn | 2475-0379 |
| language | English |
| last_indexed | 2024-03-12T09:08:57Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Research and Practice in Thrombosis and Haemostasis |
| spelling | doaj.art-6b5619582fe34a3b9426fc9ac72adb592023-09-02T15:09:06ZengElsevierResearch and Practice in Thrombosis and Haemostasis2475-03792022-05-0164n/an/a10.1002/rth2.12740Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatmentDanielle Groat0Karlyn A. Martin1Rachel P. Rosovsky2Kristen M. Sanfilippo3Manila Gaddh4Lisa Baumann Kreuziger5M. Elaine Eyster6Scott C. Woller7for the Venous thromboEmbolism Network US (VENUS) VTE Treatment, Anticoagulation Management GroupCenter for Humanizing Critical Care Intermountain Medical Center Murray Utah USADivision of Hematology/Oncology Department of Medicine Northwestern University Feinberg School of Medicine Chicago Illinois USADivision of Hematology/Oncology Department of Medicine Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USADivision of Hematology Department of Medicine Washington University School of Medicine St Louis Missouri USADepartment of Hematology and Medical Oncology Emory University School of Medicine Atlanta Georgia USABlood Research Institute Versiti Milwaukee Wisconsin USAPenn State Hershey Medical Center Hershey Pennsylvania USADepartment of Medicine Intermountain Medical Center Murray Utah USAAbstract Background The direct oral anticoagulants (DOACs), apixaban and rivaroxaban, have been studied for extended‐phase treatment of venous thromboembolism (VTE). Yet, scant evidence exists surrounding clinician practice and decision‐making regarding dose reduction. Aims Report clinician practice and characteristics surrounding dose reduction of DOACs for extended‐phase VTE treatment. Methods We conducted a 16‐question REDCap survey between July 14, 2021, and September 13, 2021, among ISTH 2021 Congress attendees and on Twitter. We explored factors associated with dose reduction using logistic regression. We used k‐means clustering to identify distinct groups of dose‐reduction decision‐making. Random forest analysis explored demographics with respect to identified groups. Results Among 171 respondents, most were attending academic physicians from North America. Clinicians who treated larger volumes of patients had higher odds of dose reduction. We identified five clusters that showed distinct patterns of behavior regarding dose reduction. Cluster 1 rarely dose reduces and likely prescribes rivaroxaban over apixaban; cluster 2 dose reduces frequently, does not consider age when dose‐reducing, is least likely to temporarily reescalate dosing, and prescribes apixaban and rivaroxaban equally; cluster 3 dose reduces <50% of the time, and temporarily reescalates dosing during increased VTE risk; cluster 4 dose reduces frequently, temporarily reescalates dosing, and is most likely to prescribe apixaban over rivaroxaban; and cluster 5 dose reduces most frequently, and takes the fewest risk factors into consideration when deciding to dose reduce. Conclusions Most clinicians elect to dose‐reduce DOACs for extended‐phase anticoagulation. The likelihood of a clinician to dose reduce increases with volume of patients treated. Clinician prescribing patterns cluster around VTE risk factors as well as reescalation during high‐risk periods.https://doi.org/10.1002/rth2.12740anticoagulantapixabanreduced‐doserivaroxabantreatmentvenous thromboembolism |
| spellingShingle | Danielle Groat Karlyn A. Martin Rachel P. Rosovsky Kristen M. Sanfilippo Manila Gaddh Lisa Baumann Kreuziger M. Elaine Eyster Scott C. Woller for the Venous thromboEmbolism Network US (VENUS) VTE Treatment, Anticoagulation Management Group Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment Research and Practice in Thrombosis and Haemostasis anticoagulant apixaban reduced‐dose rivaroxaban treatment venous thromboembolism |
| title | Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment |
| title_full | Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment |
| title_fullStr | Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment |
| title_full_unstemmed | Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment |
| title_short | Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment |
| title_sort | physician perceptions and use of reduced dose direct oral anticoagulants for extended phase venous thromboembolism treatment |
| topic | anticoagulant apixaban reduced‐dose rivaroxaban treatment venous thromboembolism |
| url | https://doi.org/10.1002/rth2.12740 |
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