Patient values and preferences for antithrombotic therapy in atrial fibrillation

Peter S. Loewen; Angela Tianshu Ji; Anita Kapanen; Alison McClean

doi:10.1160/TH16-10-0787

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2017; 117(06): 1007-1022
DOI: 10.1160/TH16-10-0787

Review Article

Schattauer GmbH

Patient values and preferences for antithrombotic therapy in atrial fibrillation

A Narrative Systematic Review

Peter S. Loewen

¹Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada

,

Angela Tianshu Ji

¹Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada

,

Anita Kapanen

¹Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada

,

Alison McClean

¹Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada

› Institutsangaben

Abstract

Summary

Guidelines recommend that patients’ values and preferences should be considered when selecting stroke prevention therapy for atrial fibrillation (SPAF). However, doing so is difficult, and tools to assist clinicians are sparse. We performed a narrative systematic review to provide clinicians with insights into the values and preferences of AF patients for SPAF antithrombotic therapy. Narrative systematic review of published literature from database inception. Research questions: 1) What are patients’ AF and SPAF therapy values and preferences? 2) How are SPAF therapy values and preferences affected by patient factors? 3) How does conveying risk information affect SPAF therapy preferences? and 4) What is known about patient values and preferences regarding novel oral anticoagulants (NOACs) for SPAF? Twenty-five studies were included. Overall study quality was moderate. Severe stroke was associated with the greatest disutility among AF outcomes and most patients value the stroke prevention efficacy of therapy more than other attributes. Utilities, values, and preferences about other outcomes and attributes of therapy are heterogeneous and unpredictable. Patients’ therapy preferences usually align with their values when individualised risk information is presented, although divergence from this is common. Patients value the attributes of NOACs but frequently do not prefer NOACs over warfarin when all therapy-related attributes are considered. In conclusion, patients’ values and preferences for SPAF antithrombotic therapy are heterogeneous and there is no substitute for directly clarifying patients’ individual values and preferences. Research using choice modelling and tools to help clinicians and patients clarify their SPAF therapy values and preferences are needed.

Supplementary Material to this article is available online at www.thrombosis-online.com.

Keywords

Atrial fibrillation - anticoagulation - antiplatelet - antithrombotic - stroke - bleeding - values - preferences - medication

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Referenzen

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