Toorop Myrthe M A, van Rein Nienke, Nierman Melchior C, Vermaas Helga W, Huisman Menno V, van der Meer Felix J M, Cannegieter Suzanne C, Lijfering Willem M
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.
J Thromb Haemost. 2020 Jun;18(6):1390-1397. doi: 10.1111/jth.14793. Epub 2020 May 6.
Since direct oral anticoagulants (DOACs) have been introduced for treatment and prevention of thromboembolic diseases, patients on vitamin K antagonists (VKA) have to decide whether to remain on VKA or switch to DOAC. The goal of this study was to evaluate treatment satisfaction, preferences, and concerns among those who already have switched from VKA to DOAC.
A questionnaire was sent to 2920 former patients of three anticoagulation clinics in the Netherlands, who switched from VKA to DOAC (2016-2017). Questions concerned demographics, treatment satisfaction, concerns, perspectives on antidotes, and monitoring. To identify predictors for being concerned about adverse events, logistic regression was used to estimate crude- and adjusted (age and sex) odds ratios (OR) and 95% confidence intervals (95% CI).
One thousand, three hundred ninety-nine questionnaires (response rate 48%) were used for analysis. DOAC treatment satisfaction was high (mean 8.8 of a maximum 10-point score). A quarter of patients expressed concerns about adverse events. Predictors for being concerned were age < 60 years (vs age > 75 years, OR 4.1, 95% CI 2.6-6.4), female sex (OR 1.3, 95% CI 1.0-1.6), and high education (OR 1.6, 95% CI 1.2-2.2). Fifty-nine percent of all patients indicated antidote availability as important, 73% would be willing to participate in DOAC monitoring.
DOAC treatment satisfaction was high. A substantial number of patients expressed concerns about adverse events, especially women, patients aged < 60 years, or highly educated patients. Our findings among patients who already had switched to DOAC may assist in the process of shared decision-making when switching a patient from VKA to DOAC is considered.
自从直接口服抗凝剂（DOACs）被用于血栓栓塞性疾病的治疗和预防以来，服用维生素K拮抗剂（VKA）的患者必须决定是继续使用VKA还是改用DOAC。本研究的目的是评估那些已经从VKA改用DOAC的患者的治疗满意度、偏好和担忧。
向荷兰三家抗凝门诊的2920名既往患者（2016 - 2017年从VKA改用DOAC）发送了问卷。问题涉及人口统计学、治疗满意度、担忧、对抗凝解毒剂的看法以及监测情况。为了确定对不良事件感到担忧的预测因素，采用逻辑回归来估计粗比值比（OR）和调整后（年龄和性别）的比值比以及95%置信区间（95%CI）。
1399份问卷（回复率48%）用于分析。DOAC治疗满意度较高（满分10分，平均8.8分）。四分之一的患者表达了对不良事件的担忧。担忧的预测因素为年龄<60岁（与年龄>75岁相比，OR 4.1，95%CI 2.6 - 6.4）、女性（OR 1.3，95%CI 1.0 - 1.6）以及高学历（OR 1.6，95%CI 1.2 - 2.2）。所有患者中有59%表示解毒剂的可获得性很重要，73%愿意参与DOAC监测。
DOAC治疗满意度较高。相当一部分患者表达了对不良事件的担忧，尤其是女性、年龄<60岁的患者或高学历患者。我们在已经改用DOAC的患者中的研究结果可能有助于在考虑将患者从VKA改用DOAC时进行共同决策的过程。
