PB0686 - Clinical decisions and factors influencing the management of persons with hemophilia requiring antithrombotic therapy: A qualitative study.

Background: With an aging population of persons with hemophilia (PWH) due to improvements in hemophilia care, the prevalence of thromboembolic events has increased. How to manage these events in PWH is challenging for patients and their clinicians, and requires additional attention to better understand how treatment plans are established.

Aims: The purpose of this study was to explore how clinicians manage the care of PWH requiring antithrombotic therapy (ATT) for thromboembolic disorders. The objectives were to understand their decision-making process and the factors influencing such decisions.

Methods: We conducted three focus groups with a total of eight subjects. Participants were physicians who have expertise in managing either hemophilia and/or thromboembolic disorders. Data analysis followed Braun and Clarke’s reflexive thematic analysis.

Results: Participants described four foundational elements underlying their decision-making, which is illustrated in Figure 1. First was the initial and repeated risk assessment of the hemostatic balance when thrombosis occurred in an individual with an inherited bleeding disorder. Second, participants discussed the careful selection of the safest option for ATT or alternative treatment strategies. Third, participants developed a hemophilia-specific treatment plan informed by prior elements. Throughout this active process, participants emphasized a fourth element referring to the continuous review and reassessment of the management plan to maximize therapeutic benefits while minimizing harm from excess bleeding or recurrent thrombotic events. Each element encompassed multiple factors that influence the decision-making process. The end-product of participants’ decision-making process aimed at formulating an individualized and co-produced patient care plan.

Conclusion(s): This study demonstrates the complexity in decision-making for the management of thromboembolic events in PWH. We present a framework to assist clinicians in their decision-making process, which could also serve as a research tool to generate evidence-based data that facilitate how we navigate the delicate hemostatic balance in PWH requiring ATT.