Deborah Layton1,2, Alison Evans1,2, Miranda Davies1,2, Vicki Osborne1,2 and Saad AW Shakir
Increasingly choice of medicines is guided by published guidelines. ROSE is being conducted as part of a risk management plan to monitor short-term (first 3 months) safety and utilisation of rivaroxaban (Riv). A contextual comparator cohort of new user patients (pts) treated via standard care (warfarin-War) is also being identified. Study objectives include advancing the understanding of use of Riv in the secondary care setting.
An interim analysis of treatment setting and factors influencing anticoagulant prescribing decisions.
An observational, population-based cohort study. The interim cohort was identified through a specialist network from Sep13 to Mar15 (data lock date), supported by UK Clinical Research Networks. Data collected via a questionnaire from consenting pt medical charts by specialists included reasons for prescribing such as guidelines. Descriptive statistics were calculated (% denominator assumed no missing data; sub-cohorts were pooled by indication: treatment/prevention of DVT/PE; prevention of stroke/systemic embolism in pts with non-valvular AF).
Interim cohort = 2022 (54% Riv vs 46% War); median age 71yrs (IQR 59, 80); 56% (1131) male; 59% (1193) were outpts; AF cohort =1118: Riv (59%), War (51%) and the DVT/PE cohort =860: Riv (39%), War (46%). Irrespective of indication, the most frequently provided prescribing reason was clinical judgement [Riv (98%), War (82%)]. Other reasons were NICE guidance [Riv (25%), War (40%)], lifestyle impact [Riv (29%), War (3%)] and formulary guidelines [Riv (15%), War (28%)]. Similar patterns were observed when data were stratified by indication group.
This interim analysis shows that in UK secondary care clinical practice, prescriber clinical judgement is the overriding factor affecting treatment choice. Whilst guidelines are important, their influence on prescribing decision differs between the two drugs. Non-clinical lifestyle considerations appear to be more important for patients treated with Riv than War. A formal multi-level analysis of determinants of prescribing is planned for the final analysis.