Assessing patient preferences for switching from warfarin to direct oral anticoagulants

  • Jack N. Wright
  • Sara R. VazquezEmail author
  • Kibum Kim
  • Aubrey E. Jones
  • Daniel M. Witt


Warfarin remains the most commonly prescribed oral anticoagulant in the United States, but it has disadvantages such as dietary interactions and frequent laboratory monitoring. Direct oral anticoagulants (DOACs) have been introduced as safer and equally effective alternatives to warfarin. This study assessed patient preference for warfarin or DOAC based on a willingness to pay more for potential DOAC benefits. Current warfarin patients with atrial fibrillation or venous thromboembolism enrolled in the University of Utah Health Thrombosis Service were given a one-time electronic survey that assessed preferences between warfarin and DOACs using scenarios comparing effectiveness, safety, and convenience. When DOACs were preferred, patients were asked how much more they would be willing to pay monthly for the perceived advantages associated with DOACs. With 123 completed surveys, 68% of patients preferred to stay on warfarin. No particular factor influenced patient preference (lack of routine laboratory monitoring, lower risks of major bleeding, and fewer dietary interactions). Reduced stroke risk was associated with the highest value (willing to pay an additional $21). Considering all factors, patients preferring DOACs would pay a median $18 extra per month for the additional benefits. Prior exposure to DOACs was associated with preference for DOACs. Many patients currently taking warfarin preferred to stay on warfarin when given the choice, despite DOAC benefits. Willingness to pay extra for DOAC advantages did not exceed $20 in the majority of survey respondents. Previous DOAC exposure influences patient preference and perceived value for DOACs.


Warfarin Direct oral anticoagulant Cost Preference Atrial fibrillation Venous thromboembolism 


Compliance with ethical standards

Conflict of interest

Sara R. Vazquez declares that she is an editorial consult for UpToDate® and a member of the Anticoagulation Forum Board of Directors. Daniel M. Witt declares that he is a member of the Anticoagulation Forum Advisory Council and has received grant funding unrelated to this study from Roche Diagnostics Corporation (RD003737). Jack N. Wright, Kibum Kim and Aubrey E. Jones declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Utah Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All patients provided written informed consent prior to study participation.

Supplementary material

11239_2019_1915_MOESM1_ESM.docx (267 kb)
Supplementary material 1 (DOCX 267 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PharmacotherapyUniversity of Utah College of PharmacySalt Lake CityUSA
  2. 2.University of Utah Health, Thrombosis ServiceSalt Lake CityUSA

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