Prescribing of NOACs has outnumbered warfarin: exploring how physicians choose anticoagulant treatments
The development of non-vitamin K-dependent oral anticoagulants (NOACs) is a new alternative to treatment with warfarin. The purpose of this study was to explore drug prescription decisions of NOACs or warfarin from hospital physicians in cardiovascular departments.
A qualitative study with focus group interviews was conducted in three different hospitals. The interview guide explored the background of prescribing anticoagulants (warfarin, dabigatran, rivaroxaban, and apixaban) and experiences with effect and side-effects they had observed in patients.
The systematic text condensation eluded four main themes: when to prescribe NOACs, concern about side-effects, pharmaceutical properties and patient adherence, and prescribing policy and intra-professional communication. All available anticoagulants were prescribed. However, no specific NOAC was preferred. Factors perceived as contraindications for NOACs varied among the doctors. Most had observed side-effects of NOACs; however, these rarely influenced prescribing decisions due to small differences in safety profiles. Few drug-drug interactions and fixed daily doses made NOACs easy to prescribe; but some doctors had experienced lack of drug effect for some patients. Non-adherence with NOACs was harder to spot. Some different prescribing cultures had evolved between the different hospitals and between general practitioners.
The hospital physicians chose anticoagulants based on patient conditions as renal function, bleeding risks, and drug interactions being the most common taken into account. They could not say which NOAC was best, and wish that future studies could compare the different NOACs, and not just compare with warfarin.
KeywordsAnticoagulants Warfarin NOAC Hospital physicians Drug prescriptions Drug-related side-effects Adverse reactions
Contributions of authors
AKE and AGG contributed to the conception or design of the work and to the acquisition and analysis of the data, and all authors to interpretation of data for the work. All drafted the manuscript and critically revised the manuscript. All gave final approval and AKE and AGG agree to be accountable for all aspects of work ensuring integrity and accuracy.
Compliance with ethical standards
This study was approved by the Norwegian Social Science Data Services (NSD). Physicians signed consent forms.
Conflict of interest
The authors declare they have no conflicts of interest.
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