Patient satisfaction after conversion from warfarin to direct oral anticoagulants for patients on extended duration of anticoagulation for venous thromboembolism - The SWAN Study.

BACKGROUND

Warfarin 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.

OBJECTIVES

To assess medication satisfaction in patients requiring anticoagulation for venous thromboembolism after conversion from warfarin to an anti-Xa direct oral anticoagulant.

METHODS

A 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.

RESULTS

The 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.

CONCLUSIONS

Patient 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.

Déclaration de conflit d'intérêts

The authors have declared that no competing interests exist. There are however several general industrial links and affiliations for authors as indicated below. Mr Scott McGregor industrial links and affiliations: Advisory boards: Gilead Sciences Conference Travel and speaker support: Roche, Bristol-Myers Squibb, Amgen, Pfizer, Abbvie, CSL, Janssen, Novartis, Takeda Equity: Bristol-Myers Squibb Professor Ross Baker industrial links and affiliations: Advisory boards: Roche Industry led Clinical Trial Support payment to Institution: Bayer, Shire, Pfizer, Daiichi, Sankyo, and CSL Behring, Roche, Amgen, Celgene, Rigel Pharmaceuticals, Abbvie, Sanofi, MorphoSys AG, Acerta Pharma, Jansen-Cileg Conference Travel and speaker support: Shire, Roche, CSL Behring, Bayer, BMS, Novo Nordisk Research support from: Shire, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Portola, Technoclone This does not alter our adherence to PLOS ONE policies on sharing data and materials.'