title: Attending Physician Attitudes Toward Choice of Oral Anticoagulant for the Treatment of Venous Thromboembolism.
abstract: Until recently, warfarin has been the primary treatment of venous thromboembolism (VTE). Limited data are available regarding physician attitudes toward anticoagulant choice in the setting of novel oral anticoagulant (NOAC) availability. This study sought to evaluate attending physician attitudes toward NOACs. A survey was sent to attending physicians from internal medicine (primary care and hospitalist medicine), family medicine, cardiology, and hematology-oncology asking about their preference and reasoning for choice of oral anticoagulant for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE). Warfarin was the most common choice of initial treatment of both DVT (85.6%) and PE (89%). Among the specialties surveyed, cardiologists were more likely to use rivaroxaban as initial treatment of VTE as compared to other specialties including internal medicine or hematology (p=0.011 for DVT and 0.004 for PE). Cost-effectiveness and lack of a reversal agent were cited as the major disadvantages for NOAC use.
authors.affiliation: Instructor in Medicine at Harvard Medical School and an Associate Physician in the Hematology Division at Brigham and Women's Hospital in Boston, MA. He was previously a Teaching Fellow in Hematology and Medical Oncology at the Warren Alpert Medical School of Brown University and The Rhode Island and Miriam Hospitals.
authors.forename: Nathan T
authors.initials: NT
authors.lastname: Connell
authors.affiliation: Clinical Associate Professor of Medicine at the Warren Alpert Medical School of Brown University and a hematologist/oncologist in the Department of Medicine at Rhode Island Hospital in Providence, RI.
authors.forename: James N
authors.initials: JN
authors.lastname: Butera
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D002309:Cardiology / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D000069604:Dabigatran / Q000191:economics / Q000627:therapeutic use*; D019538:Health Care Surveys; D006405:Hematology / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012237:Rhode Island / Q000453:epidemiology; D000069552:Rivaroxaban / Q000191:economics / Q000627:therapeutic use*; D013038:Specialization; D054556:Venous Thromboembolism / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
keywords: Dabigatran etexilate; Physician practice patterns; Rivaroxaban; Venous thromboembolism; Warfarin