European expert consensus recommendations on the primary care use of direct oral anticoagulants in patients with venous thromboembolism

Carter Patrice; Fuat Ahmet; Haas Sylvia; Smyth Elizabeth; Brotons Carlos; Cools Frank; Bauersachs Rupert; Hobbs F D Richard

doi:10.1186/s12875-024-02314-7

European expert consensus recommendations on the primary care use of direct oral anticoagulants in patients with venous thromboembolism

BMC Prim Care. 2024 Mar 18;25(1):90. doi: 10.1186/s12875-024-02314-7.

Authors

Carter Patrice¹, Fuat Ahmet^{2

3}, Haas Sylvia⁴, Smyth Elizabeth⁵, Brotons Carlos⁶, Cools Frank⁷, Bauersachs Rupert^{8

9}, Hobbs F D Richard¹⁰

Affiliations

¹ Health Economics & Outcomes Research Ltd, Rhymney House, Unit A Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8RB, UK. patrice.carter@heor.co.uk.
² School of Health, University of Durham, Durham, DH1, 3LE, UK.
³ Primary Care, Durham University, Durham, UK.
⁴ Formerly Technical University of Munich, Munich, Germany.
⁵ Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
⁶ Sardenya Primary Health Care Centre-Institut de Recerca Sant Pau, Barcelona, Spain.
⁷ AZ Klina, Department of Cardiology, Augustijnslei 100, Brasschaat, 2930, Belgium.
⁸ Center of Vascular Research - VASC, Munich, Germany.
⁹ Cardioangiologic Center, Bethanien CCB, Frankfurt, Germany.
¹⁰ Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK.

Abstract

Background: Direct oral anticoagulants for the treatment of venous thromboembolism are supported by robust clinical trial evidence. Despite published guidance, general practitioners are faced with increasingly complex decisions and implementation remains sub-optimal in certain real-world scenarios.

Methods: A two stage formal consensus exercise was performed to formulate consensus statements and a summary guide, facilitating optimal management of direct oral anticoagulants in venous thromboembolism patients by generalist physicians across Europe. An online questionnaire distributed to a broad panel (Phase 1), followed by a virtual panel discussion by an expert group (Phase 2) were conducted. Phase 1 statements covered nine management domains, and were developed via a literature review and expert steering committee. Participants rated statements by their level of agreement. Phase 1 responses were collated and analysed prior to discussion and iterative refinement in Phase 2.

Results: In total 56 participants from across Europe responded to Phase 1. The majority had experience working as general practitioners. Consensus indicated that direct oral anticoagulants are the treatment of choice for managing patients with venous thromboembolism, at initiation and for extended treatment, with a review at three to six months to re-assess treatment effect and risk profile. Direct oral anticoagulant choice should be based on individual patient factors and include shared treatment choice between clinicians and patients; the only sub-group of patients requiring specific guidance are those with cancer.

Conclusion: Results demonstrate an appreciation of best practices, but highlight challenges in clinical practice. The patient pathway and consensus recommendations provided, aim to highlight key considerations for general practice decision making, and aid optimal venous thromboembolism treatment.

Keywords: Cancer associated thromboembolism, Primary Care; Direct oral anticoagulants (DOACs); Formal consensus; Venous thromboembolism (VTE).

Publication types

Review

MeSH terms

Anticoagulants / therapeutic use
Humans
Neoplasms* / drug therapy
Patients
Primary Health Care
Venous Thromboembolism* / drug therapy

Substances

Anticoagulants