Lenert Leslie A, Scherbakov Dmitry, Shaoibi Azza, Neelon Brian, Reynolds Amy, Kernan Laura, Lambourne Carol A, Pellegrini Vincent D
Res Sq. 2025 Aug 6:rs.3.rs-7289754. doi: 10.21203/rs.3.rs-7289754/v1.
Patients who receive hip or knee replacement surgery should be anticoagulated to prevent thrombosis-related events, such as pulmonary embolism. The Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER) is a large pragmatic trial studying which anticoagulant (aspirin, warfarin, or rivaroxaban) is optimal. As an adjunct to this study, we examined the role of patients' preferences in individual tailoring of therapy.
We constructed a multimedia conjoint analysis (CA) survey based on anticoagulants' beneficial and adverse effects at the expected probabilities being studied in the PEPPER trial. We recruited 212 hip and knee post-surgery patients at the Medical University of South Carolina who were eligible for the PEPPER trial and studied their preferences one to seven months after surgery. K-means clustering was used to characterize heterogeneity in patients' preferences.
Across the studied population, expected risks of major adverse effects (bleeding, venous thrombosis, and pulmonary embolism) were, on average, rated as being of similar importance, with somewhat greater weight being placed on avoiding risks of pulmonary embolism. However, few patients had values near the average for the population, with patients grouping in three distinct, minimally-overlapping segments or phenotypes: Thrombosis-focused values (aligns with rivaroxaban treatment), Balanced values (bleeding and thrombosis-focus (aligns with aspirin)), and "Out-of-pocket-cost focused values (aligns with aspirin or warfarin).
In the post-knee/hip replacement setting, a CA survey revealed that patients value the risks and benefits of anticoagulation differently, falling into three distinct phenotypes that have implications for the individualization of therapy. Providers should tailor post-operative anticoagulation to patients' preferences.
接受髋关节或膝关节置换手术的患者应进行抗凝治疗，以预防血栓相关事件，如肺栓塞。髋关节和膝关节置换术后肺栓塞预防（PEPPER）试验是一项大型实用试验，旨在研究哪种抗凝剂（阿司匹林、华法林或利伐沙班）是最佳选择。作为该研究的补充，我们研究了患者偏好在个体化治疗中的作用。
我们基于PEPPER试验中所研究的抗凝剂在预期概率下的有益和不良反应，构建了一项多媒体联合分析（CA）调查。我们招募了南卡罗来纳医科大学212名符合PEPPER试验条件的髋关节和膝关节置换术后患者，并在术后1至7个月研究了他们的偏好。采用K均值聚类来描述患者偏好的异质性。
在整个研究人群中，主要不良反应（出血、静脉血栓形成和肺栓塞）的预期风险平均被认为具有相似的重要性，其中避免肺栓塞风险的权重略大。然而，很少有患者的值接近人群平均值，患者分为三个不同的、几乎不重叠的组或表型：以血栓形成为重点的值（与利伐沙班治疗一致）、平衡值（出血和血栓形成重点（与阿司匹林一致））以及“自付费用重点值（与阿司匹林或华法林一致）。
在膝关节/髋关节置换术后的情况下，一项CA调查显示，患者对抗凝治疗的风险和益处的重视程度不同，分为三种不同的表型，这对治疗个体化具有重要意义。医疗服务提供者应根据患者的偏好调整术后抗凝治疗。
