Prescribing of NOACs has outnumbered warfarin: exploring how physicians choose anticoagulant treatments

• Published in: European journal of clinical pharmacology 2018-03, Vol.74 (3), p.323-330
• Main Authors: Eek, Anne Katrine, Øie, Erik, Granas, Anne Gerd
• Format: Article
• Language: English
• Subjects: Administration, Oral; Anticoagulants; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Antithrombins - administration & dosage; Antithrombins - adverse effects; Antithrombins - therapeutic use; Biomedical and Life Sciences; Biomedicine; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - prevention & control; Clinical Decision-Making; Culture; Dabigatran - administration & dosage; Dabigatran - adverse effects; Dabigatran - therapeutic use; Drug Monitoring; Drug Resistance; Factor Xa Inhibitors - administration & dosage; Factor Xa Inhibitors - adverse effects; Factor Xa Inhibitors - therapeutic use; Family physicians; Focus Groups; General Practitioners; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Hemorrhage - prevention & control; Hospitals; Humans; Medical personnel; Medical Staff, Hospital; Medication Adherence; Norway - epidemiology; Pharmacoepidemiology and Prescription; Pharmacology/Toxicology; Practice Patterns, Physicians; Pyrazoles - administration & dosage; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Pyridones - administration & dosage; Pyridones - adverse effects; Pyridones - therapeutic use; Qualitative Research; Renal function; Risk; Rivaroxaban - administration & dosage; Rivaroxaban - adverse effects; Rivaroxaban - therapeutic use; Side effects; Vitamin K; Warfarin; Warfarin - adverse effects; Warfarin - therapeutic use
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-017-2374-4

Purpose The development of non-vitamin K-dependent oral anticoagulants (NOACs) is a new alternative to treatment with warfarin. The purpose of this study was to explore drug prescription decisions of NOACs or warfarin from hospital physicians in cardiovascular departments. Methods A qualitative study with focus group interviews was conducted in three different hospitals. The interview guide explored the background of prescribing anticoagulants (warfarin, dabigatran, rivaroxaban, and apixaban) and experiences with effect and side-effects they had observed in patients. Results The systematic text condensation eluded four main themes: when to prescribe NOACs, concern about side-effects, pharmaceutical properties and patient adherence, and prescribing policy and intra-professional communication. All available anticoagulants were prescribed. However, no specific NOAC was preferred. Factors perceived as contraindications for NOACs varied among the doctors. Most had observed side-effects of NOACs; however, these rarely influenced prescribing decisions due to small differences in safety profiles. Few drug-drug interactions and fixed daily doses made NOACs easy to prescribe; but some doctors had experienced lack of drug effect for some patients. Non-adherence with NOACs was harder to spot. Some different prescribing cultures had evolved between the different hospitals and between general practitioners. Conclusion The hospital physicians chose anticoagulants based on patient conditions as renal function, bleeding risks, and drug interactions being the most common taken into account. They could not say which NOAC was best, and wish that future studies could compare the different NOACs, and not just compare with warfarin.