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The introduction of the direct oral anticoagulants (DOACs) has led to their widespread use for stroke prevention and venous thromboembolism, but little is known about the numbers of patients switching from a DOAC to (or back to) a warfarin or the reasons for doing so. This study was an analysis of prospectively collected data from a 4-year period surveying a warfarin dose adjustment clinic in a large city centre hospital with the primary objective to identify these reasons. In our clinic with 1791 patients annually under review, 40 patients were identified as having switched from a DOAC to warfarin with the most common reasons for switching being bleeding, re-thrombosis and renal deterioration. Other reasons included medication interactions, side effects, antiphospholipid syndrome, valvular replacement or arterial embolism. Clinical events following warfarin commencement were also recorded. Overall, these data suggest that switching from a DOAC to warfarin is seldom deemed necessary by clinicians. However, as the number of patients receiving DOACs continues to increase, it is vital that health care professionals remain vigilant regarding medication interactions, bleeding risk and changing renal function.

Multiple myeloma (MM) is associated with an increased risk of venous thrombosis (VTE). In the United Kingdom Medical Research Council (MRC) XI study of patients treated with immunomodulatory therapy, the VTE rate was 11.8% despite 87.7% of the patients being on thromboprophylaxis at the time of thrombosis. In order to effectively prevent VTE events in MM patients, a better understanding of patient and disease risk factors that might predict thrombosis is required. We performed a retrospective cohort analysis of over 300 newly diagnosed MM patients at a tertiary referral centre to determine the VTE rate, predictive factors for VTE, value of the Khorana score for MM VTE events and long-term mortality outcomes. Fifty-four percent of the patients were receiving thromboprophylaxis at the time of the VTE event. The mortality odds ratio was 3.3 (95% CI, 2.4–4.5) in patients who developed VTE in comparison to age-matched controls with MM. A younger age at diagnosis and higher white cell count (WCC) were found to be predictive of VTE events. Our data suggest that standard thromboprophylaxis may not be effective in preventing VTE events in myeloma patients, and alternative strategies, which could include higher-intensity thromboprophylaxis in young patients with a high WCC, are necessary.

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Objectives: Since the introduction of non-vitamin-K-antagonist oral anticoagulants (OACs), an additional option for stroke prevention in patients with atrial fibrillation (AF) compared to vitamin-K-antagonists (VKAs) is available. The objective of this study was to assess patients' preferences regarding the attributes of these different treatment options. MethOds: We conducted a multicenter study among randomly selected physicians who were asked to recruit AF patients. Patients' preferences were assessed by computer-assisted telephone interviews. We used a Discrete-Choice-Experiment (DCE) with four treatment dependent attributes (need of bridging: yes/no, interactions with food/nutrition: yes/no, need of INR controls/ dose adjustment: yes/no, frequency of intake: once/twice daily) and one comparator attribute (distance to practitioner: < 1km/> 15km). Preferences measured in the interviews were analyzed descriptively and based on a conditional logistic regression model. Results: A total of 140 AF patients (age: 74.0±8.5 years; 57.0% male; mean CHA 2 DS 2 -VASc: 6.1±1.1; current medication: 27.1% rivaroxaban, 71.4% VKA, 1.4% other) could be interviewed. Regardless of type of medication, patients significantly preferred the attributes' level (in order of patients' importance) "once daily" for "frequency of intake" (binary-coded: once = 1 vs. twice = 0; Coefficient = 0.954; p< 0.001), "no" for "interaction with food/nutrition" (yes vs. no; -0.842; p< 0.001), "no" for "bridging necessary" (yes vs. no; -0.656; p< 0.001) and "≤ 1 km" for "distance to practitioner" (≤ 1 km vs. > 15 km; 0.644; p< 0.001). However, for the attribute "need of INR controls/dose adjustment" (yes vs. no; 0.020; p= 0.808) no significant preference in favour of one of the options are shown. cOnclusiOns: In our analyses, "once daily frequency of intake" was the most important attribute for patients' choice followed by "no interactions with food/nutrition" and "no bridging necessary". Thus, patients with AF seem to prefer treatment options which are easier to administer.