Groat Danielle, Martin Karlyn A, Rosovsky Rachel P, Sanfilippo Kristen M, Gaddh Manila, Baumann Kreuziger Lisa, Federici Elizabeth, Woller Scott C
Center for Humanizing Critical Care, Intermountain Medical Center, Murray, UT 84107, USA.
Division of Hematology/Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
J Clin Med. 2023 Dec 23;13(1):96. doi: 10.3390/jcm13010096.
The direct anticoagulants (DOACs), apixaban and rivaroxaban, are used for extended-phase treatment of venous thromboembolism (VTE) and have labeling for dose reduction for this indication. The objective of this study was to better understand primary care clinician prescribing patterns of apixaban and rivaroxaban for extended-phase anticoagulation. We conducted a 21-question survey targeting members of the American College of Physicians and United States Veterans Administration anticoagulation management services. Survey questions covered prescribing behaviors for dose reduction of apixaban and rivaroxaban for extended VTE treatment, as well as questions related to the respondent's practice setting. We used logistic regression to assess associations between demographics and prescribing behaviors. We used k-means clustering to identify distinct groups of prescribing patterns. Among 227 respondents, most were attending physicians (60%) and one-third (34%) practiced in internal medicine or primary care. Most (59%) indicated they dose-reduced DOACs. Hospitalists (no outpatient care) were least likely to dose-reduce (OR 0.09 [95% CI 0.03-0.22]), as well as early-career clinicians (0.53 [0.30-0.91]). Pharmacists and clinicians who treat over 500 VTE patients annually were most likely to dose reduce (6.4 [2.9-16.3]), (2.9 [1.5-6.0]), respectively. We identified five clusters of dosing behaviors and characterized clinician makeup. Clusters were primarily differentiated by frequency of dose reduction, DOAC preference, and temporary re-escalation of doses. We identified clinician characteristics that are associated with dose-reduction prescribing behaviors; these analyses provide insight into where targeted interventions, such as protocolization and education, would be most beneficial.
直接口服抗凝剂（DOACs）阿哌沙班和利伐沙班用于静脉血栓栓塞症（VTE）的延长阶段治疗，并且有针对该适应症的剂量减少的标签说明。本研究的目的是更好地了解基层医疗临床医生使用阿哌沙班和利伐沙班进行延长阶段抗凝治疗的处方模式。我们针对美国医师协会成员和美国退伍军人事务部抗凝管理服务部门开展了一项包含21个问题的调查。调查问题涵盖了阿哌沙班和利伐沙班用于延长VTE治疗时剂量减少的处方行为，以及与受访者执业环境相关的问题。我们使用逻辑回归来评估人口统计学特征与处方行为之间的关联。我们使用k均值聚类来识别不同的处方模式组。在227名受访者中，大多数是主治医师（60%），三分之一（34%）在内科或基层医疗领域执业。大多数（59%）表示他们会减少DOACs的剂量。住院医师（无门诊护理）减少剂量的可能性最小（比值比0.09 [95%置信区间0.03 - 0.22]），早期职业临床医生也是如此（0.53 [0.30 - 0.91]）。每年治疗超过500例VTE患者的药剂师和临床医生最有可能减少剂量（分别为6.4 [2.9 - 16.3]），（2.9 [1.5 - 6.0]）。我们识别出了五种剂量行为聚类并描述了临床医生构成。聚类主要通过剂量减少频率、DOAC偏好和剂量的临时重新增加来区分。我们识别出了与剂量减少处方行为相关的临床医生特征；这些分析为诸如制定方案和开展教育等有针对性的干预措施最有益的领域提供了见解。
