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. 2017 Feb;10(1):17-37.
doi: 10.1007/s40271-016-0185-9.

Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

Thomas Wilke  1 , Sabine Bauer  2 , Sabrina Mueller  2 , Thomas Kohlmann  3 , Rupert Bauersachs  4   5
Affiliations

Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

Thomas Wilke et al. Patient. 2017 Feb.

Abstract

Objectives: Since the introduction of non-vitamin K antagonist (VKA) oral anticoagulants (NOACs), an additional treatment option, apart from VKAs, has become available for stroke prevention in patients with atrial fibrillation (AF). For various reasons, it is important to consider patients' preferences regarding type of medication, particularly in view of the established relationship between preferences towards treatment, associated burden of treatment, and treatment adherence. This review aimed to systematically analyse the scientific literature assessing the preferences of AF patients with regard to long-term oral anticoagulant (OAC) treatment.

Methods: We searched the MEDLINE, Scopus and EMBASE databases (from 1980 to 2015), added records from reference lists of publications found, and conducted a systematic review based on all identified publications. Outcomes of interest included any quantitative information regarding the opinions or preferences of AF patients towards OAC treatment, ideally specified according to different clinical or convenience attributes describing different OAC treatment options.

Results: Overall, 27 publications describing the results of studies conducted in 12 different countries were included in our review. Among these, 16 studies analysed patient preferences towards OACs in general. These studies predominantly assessed which benefits (mainly lower stroke risk) AF patients would require to tolerate harms (mainly higher bleeding risk) associated with an OAC. Most studies showed that patients were willing to accept higher bleeding risks if a certain threshold in stroke risk reduction could be reached. Nevertheless, most of the publications also showed that the preferences of AF patients towards OACs may differ from the perspective of clinical guidelines or the perspective of physicians. The remaining 11 studies included in our review assessed the preferences of AF patients towards specific OAC medication options, namely NOACs versus VKAs. Our review showed that AF patients prefer easy-to-administer treatments, such as treatments that are applied once daily without any food/drug interactions and without the need for bridging and frequent blood controls.

Conclusion: Stroke risk reduction and a moderate increase in the risk of bleeding are the most important attributes for an AF patient when deciding whether they are for or against OAC treatment. If different anticoagulation options have similar clinical characteristics, convenience attributes matter to patients. In this review, AF patients favour attribute levels that describe NOAC treatment.

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Conflict of interest statement

Compliance with Ethical StandardsConflicts of interestThomas Wilke has received honoraria from various pharmaceutical companies, including Novo Nordisk, GlaxoSmithKline, Bayer, Bristol-Myers Squibb, and Sanofi-Aventis; Thomas Kohlmann has received honoraria from Bayer Vital GmbH, Germany; Rupert Bauersachs has acted as a consultant for Boehringer Ingelheim Pharma, Bayer Vital GmbH, Germany, and Bristol-Myers Squibb. Sabine Bauer and Sabrina Müller have no conflicts of interest to declare.FundingThis study was financially supported by Bayer Vital GmbH, Germany.Author ContributionsThomas Wilke participated in the conception, planning and interpretation of this study, drafted the manuscript, and approved the final version. He also acts as overall guarantor for this work.Sabine Bauer participated in the planning and analysis of the data, critically reviewed the draft manuscript, and approved the final version.Sabrina Müller participated in the conception and planning of the work, critically reviewed the manuscript, and approved the final version.Thomas Kohlmann participated in the conception of the work, critically reviewed the manuscript, and approved the final version.Rupert Bauersachs participated in the conception of the work, critically reviewed the manuscript, and approved the final version.

Figures

Fig. 1
Fig. 1
PRISMA flowchart illustrating the study selection process
Fig. 2
Fig. 2
Main characteristics of the included studies. VKA vitamin K antagonist, NOAC non-VKA oral anticoagulant, OAC oral anticoagulant, AF atrial fibrillation, NA not applicable, DCE discrete choice experiment
See this image and copyright information in PMC

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