Physician perceptions and use of reduced‐dose direct oral anticoagulants for extended phase venous thromboembolism treatment

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. Report clinician practice and characteristics surr...

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Bibliographic Details
Published in:Research and practice in thrombosis and haemostasis 2022-05, Vol.6 (4), p.e12740-n/a, Article e12740
Main Authors: Groat, Danielle, Martin, Karlyn A., Rosovsky, Rachel P., Sanfilippo, Kristen M., Gaddh, Manila, Kreuziger, Lisa Baumann, Eyster, M. Elaine, Woller, Scott C.
Format: Article
Language:English
Subjects:
anticoagulant
Anticoagulants
apixaban
Cancer
Decision making
Decision trees
Demographics
FDA approval
Original
Patients
Prevention
Pulmonary embolisms
reduced‐dose
rivaroxaban
Social networks
Thromboembolism
Thrombosis
treatment
venous thromboembolism
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Summary: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. Report clinician practice and characteristics surrounding dose reduction of DOACs for extended‐phase VTE treatment. 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. 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
ISSN:2475-0379
2475-0379
DOI:10.1002/rth2.12740