Abstract
BackgroundWarfarin is an anticoagulant medication proven effective in the initial treatment and secondary prevention of venous thromboembolism. Anti-Xa direct oral anticoagulants are alternatives to warfarin; however there is limited data assessing satisfaction after switching from warfarin to an anti-Xa direct oral anticoagulant in patients for treatment of venous thromboembolism.ObjectivesTo assess medication satisfaction in patients requiring anticoagulation for venous thromboembolism after conversion from warfarin to an anti-Xa direct oral anticoagulant.MethodsA retrospective cohort study with prospective assessment of satisfaction and review of adverse events following anti-Xa direct oral anticoagulant replacement of warfarin for treatment of venous thromboembolism. Out of 165 patients who had switched from warfarin to rivaroxaban or apixaban from an outpatient haematology practice, 126 patients consented for a survey of patient’s relative satisfaction of anti-Xa direct oral anticoagulant therapy compared with previous warfarin therapy using the Anti-Clot Burden and Benefits Treatment Scale and SWAN Score.ResultsThe mean Anti-Clot Burden and Benefits and SWAN Score was 93% (56/60) and 83% (24.8/30) respectively reflecting high satisfaction with anti-Xa direct oral anticoagulants. 120 patients stated preference for anti-Xa direct oral anticoagulants over warfarin. Leading perceptions driving this was the reduction in frequency of medical contact and fewer bleeding side effects. Thirteen patients (10.3%) experienced an adverse event after the anti-Xa direct oral anticoagulant switch (majority were non-major bleeding) but most remained on anti-Xa direct oral anticoagulant treatment after management options were implemented with continued high satisfaction scores.ConclusionsPatient satisfaction with anti-Xa direct oral anticoagulant therapy for the treatment and prevention of venous thromboembolism after switching from warfarin in routine clinical practice appeared high. Improved patient convenience including reduced frequency of medical contact and fewer unpredictable side effects were perceived as significant advantages of anti-Xa direct oral anticoagulants compared to warfarin.
Highlights
Atrial fibrillation (AF), venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) and prosthetic heart valves remain the most common indications for warfarin therapy
Out of 165 patients who had switched from warfarin to rivaroxaban or apixaban from an outpatient haematology practice, 126 patients consented for a survey of patient’s relative satisfaction of anti-Xa direct oral anticoagulant therapy compared with previous warfarin therapy using the Anti-Clot Burden and Benefits Treatment Scale and SWAN Score
Improved patient convenience including reduced frequency of medical contact and fewer unpredictable side effects were perceived as significant advantages of antiXa direct oral anticoagulants compared to warfarin
Summary
Atrial fibrillation (AF), venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) and prosthetic heart valves remain the most common indications for warfarin therapy. [2] The DOACs are growing in popularity among physicians prescribing anticoagulants, and both apixaban and rivaroxaban ranked in the top four medications undergoing the most significant volume change over a one-year period from 2016 to 2017 in Australia. [4,5,6,7] Patients with high risk of recurrence of VTE such as those suffering from an unprovoked VTE, have the choice of long-term risk reduction with dose reduced DOAC anticoagulation for secondary prevention of recurrent VTE with a low risk of major bleeding. Anti-Xa direct oral anticoagulants are alternatives to warfarin; there is limited data assessing satisfaction after switching from warfarin to an anti-Xa direct oral anticoagulant in patients for treatment of venous thromboembolism
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