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    Poster Networking

    Hemophilia and Rare Bleeding Disorders

    Poster Networking Session

    PB1312 - “The doctor says so” – Patient Values and Preferences Regarding Resumption of Oral Anticoagulation After Gastrointestinal Bleeding

    Tuesday, June 27, 2023
    18:30 – 19:30 ET
    Room: Exhibition
    Background: Gastrointestinal (GI) bleeding is the most common site of bleeding associated with oral anticoagulation (OAC), and results in OAC discontinuation. Despite evidence of benefit to resuming OAC after GI bleeding, little is known about patients’ perspectives on these situations.

    Aims: We aimed to understand patient values and preferences about resuming OAC after GI bleeding and the factors that influence their decision-making.

    Methods: We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Adults with GI bleeding (within 2 years) on OAC for any indication were eligible. Interviews were transcribed verbatim and analyzed independently in duplicate with NVivo using inductive thematic analysis (CIHR #452782).

    Results: 13 participants were enrolled (11 individual interviews and 1 focus group). Four themes were identified: 1) involvement in decision-making; 2) factors affecting decision-making about resuming OAC; 3) preferences about resuming OAC; 4) communication and coordination of care.

    Participants were rarely asked about preferences for resuming OAC by physicians. They preferred to defer decisions about resuming OAC to their physicians because of trust in the physicians to make the right decision. Other factors participants considered included personal and family experiences with thrombosis, a bleeding source that was identified and treated, and fear of thrombosis while off OAC. Most participants preferred not to be involved in decision-making despite an understanding of their health issues and treatment options. Although some participants acknowledged the risk of rebleeding, they were also concerned about the risk of thrombosis. Participants desired better communication between physicians managing their OAC.

    Conclusion(s): Preferences about resuming OAC after GI bleeding were rarely elicited from patients. Although most patients preferred physicians to make decisions about resuming OAC, we identified several factors important to patients to inform and improve shared decision-making. These findings will inform a discrete choice experiments study to better understand patients’ perspectives.