What Drives Anticoagulant Choice in Pulmonary Embolism?


TOPLINE:

Emergency and hospital medicine physicians often chose anticoagulants for acute pulmonary embolism (PE) based on institutional culture and past practices rather than clinical guidelines. Common barriers included a lack of strong opinions on anticoagulant efficacy and the influence of therapeutic inertia.

METHODOLOGY:

  • Researchers conducted semi-structured interviews of emergency medicine and hospital medicine physicians across the United States from February 1 to June 3, 2024, to identify the barriers and facilitators influencing initiation of guideline-compliant anticoagulant therapy in patients hospitalized with acute PE.
  • Overall, 46 interviewees (median age, 43 years; 71.7% men; 54.3% emergency medicine physicians, 37.0% hospitalists, and 8.7% interventionalists) participated.
  • Participants were asked questions related to their choice of anticoagulants, as well as the barriers and facilitators to anticoagulant selection, via videoconferencing.
  • Their responses were analyzed and common themes and factors associated with anticoagulant selection were identified.

TAKEAWAY:

  • Many participants believed that their choice of anticoagulants did not matter, and all anticoagulants were equally effective and had comparable risks.
  • The choice of one anticoagulant over another was attributed to treatment momentum and institutional culture and influenced by peer pressure or the preferences of the in-patient team.
  • The factors associated with the unfractionated heparin (UFH)–dominant approach were the belief that it has faster clearance, the perception that it is stronger and more effective than low–molecular-weight heparin (LMWH), and a misunderstanding of its role in catheter-directed treatments.
  • The factor associated with the LMWH-dominant approach was the belief that UFH was resource intensive for healthcare staff.

IN PRACTICE:

“Although clinicians may possess knowledge of pharmacology and risks and benefits, they do not necessarily access this knowledge readily when making decisions and may rely on more pragmatic, fast-thinking heuristics when in the busy ED [emergency department] setting,” the authors wrote.

“Addressing these misconceptions and changing clinical practice will require a multifaceted approach, including pragmatic trials of anticoagulation effectiveness and safety in clinical settings, targeted educational programs from professional societies, and adoption of evidence-based policies by institutional quality committees,” wrote the author of an invited commentary.

SOURCE:

The study was led by William B. Stubblefield, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. It was published online on January 3, 2025, in JAMA Network Open.

LIMITATIONS:

The qualitative nature of the study limits its generalizability to all practice settings. Social desirability bias and subjective interpretation of qualitative data were also noted as potential limitations. 

DISCLOSURES:

This study was supported, in part, by the Baystate Medical Center Research Pilot Award Program and the Vanderbilt Faculty Research Scholars Program. Some authors reported receiving personal fees from Pfizer, Bristol Myers Squib, Janssen, Anthos, Bayer, Boston Scientific Consulting, AstraZeneca, Sanofi, and Abbott Vascular outside the submitted work. One author served on the Anticoagulation Forum Board of Directors during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.



Source link : https://www.medscape.com/viewarticle/what-drives-anticoagulant-choice-pulmonary-embolism-2025a10002d2?src=rss

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Publish date : 2025-01-30 10:56:04

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