title: Development of recommendations to continue anticoagulation with one of the two types of oral anticoagulants based on the identification of patients' preference.
abstract: Patients with indication for anticoagulation may prefer treatment with a vitamin K antagonist (VKA) or non-vitamin K antagonist oral anticoagulant (NOAC). A questionnaire may help to identify the preference of patients for one of the two types of oral anticoagulants and to develop a score for the recommendation to continue or to change the anticoagulant. A score was developed using a questionnaire containing biographic data and eight statements on attitudes on anticoagulation and was derived to trigger continuation or change the type of anticoagulant by defining ranges of terms and weighting of the significant statements identified by logistic regression analysis. Participating patients received either anticoagulation with VKA (group 1, n = 690), were transferred from VKA to NOAC (group 2, n = 158), received NOAC de novo (group 3, n = 137) or were transferred from NOAC to VKA (group 4, n = 19). Four statements were significantly (p values between 0.0347 and < 0.0001) associated with recommendations to maintain or to change the type of anticoagulant for patients in groups 1, 2, or 3 with predictive values of c = 0.83 between groups 1 and 2 and c = 0.71 between groups 1 and 3. From the total number of replies to the statements a score of three grades and two strengths (A = strong, B = moderate) was derived for the recommendations. This tool supports recommendations as to continue or to change the presently used type of oral anticoagulant based on the identification of patients' preferences.
authors.affiliation: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Zolfaghari
authors.affiliation: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
authors.forename: Job
authors.initials: J
authors.lastname: Harenberg
authors.affiliation: Central Institute for Mental Health, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Frölich
authors.affiliation: Department of Biometry and Statistics, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Department of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls University Heidelberg, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Wehling
authors.affiliation: Center for Thrombosis and Hemostasis, Mainz, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Wild
authors.affiliation: German Center for Cardiovascular Research (DZHK), Mainz, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Prochaska
authors.affiliation: Division of Angiology, Department of Medicine III, University Hospital Carl Gustav Carus Dresden Center for Vascular Medicine, Dresden, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Beyer-Westendorf
authors.affiliation: Institute for Transfusion Medicine, Charité-University Hospital, Berlin, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Koscielny
authors.affiliation: University of Birmingham Centre for Cardiovascular Sciences City Hospital Birmingham, Birmingham, United Kingdom.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D004359:Drug Therapy, Combination / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires
chemical_list: D000925:Anticoagulants