Treatment of venous thromboembolism with vitamin K antagonists: patients' health state valuations and treatment preferences
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Summary: Determining the optimal duration of vitamin K antagonist (VKA) therapy for patients with venous thromboembolism (VTE) requires a weighting of the benefits and risks of treatment. The objectives of our study were to investigate patient variability in health state valuations associated with VKA therapy and treatment preferences, and to investigate the extent to which valuations and treatment preferences are associated with prior experience with these health states and other patient characteristics. Valuations of outcomes after VTE scaled from 0 (tantamount to death) to 1 (tantamount to perfect health) were elicited from 53 patients who had experienced VTE, 23 patients who had experienced major bleeding during treatment, and 48 patients with the post-thrombotic syndrome. In addition, patients’ treatment preferences were evaluated using treatment trade-off questions. Median health state valuations ranged from 0.33 for ‘non-fatal haemorrhagic stroke’ to 0.96 for ‘no VKA treatment’. Variability between patients was substantial. Patients’ treatment preferences also varied: 25% of patients chose cessation of treatment, regardless of the probability of recurrent VTE presented, whereas 23% of patients were never willing to choose cessation of treatment. Differences in valuations and treatment preferences were not associated with type of event experienced. Due to the substantial and unpredictable variability in valuations and treatment preferences, recommendations regarding treatment duration should be tailored to patients’ specific values and concerns.
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Patients placed a high value on the benefits of risk reduction in VTE recurrence and PTS.
“Patients placed a high value on the benefits of risk reduction in VTE recurrence and PTS. 311”
From American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism (2020) · cites this paper as [311]
The Treatment preferences section shows that some patients favored continued treatment to reduce recurrent VTE risk, but preferences varied substantially; 25% chose cessation regardless of the recurrence risk presented. The Discussion reports a median health-state value of 0.82 for post-thrombotic syndrome (PTS), but the paper did not assess how patients valued a reduction in PTS risk. The claim overgeneralizes the VTE finding and extends it to PTS risk reduction. (LLM, conf=0.84)
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- Authors
- Bossuyt, P., Stalmeier, P., Sprangers, M., van Dongen, C., Middeldorp, S., Bank, I., van der Meer, J., Hamulyák, K., Prins, M., & Locadia, M.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Radboud University Nijmegen (NL)
- Maastricht University Medical Centre (NL)
- Corresponding author
- Locadia, Mirjam
- Venue
- Thrombosis and Haemostasis
- Publisher
- Georg Thieme Verlag KG
- Published
- 2004
- Volume
- 92
- Issue
- 12
- Pages
- 1336-1341
- ISSN
- 0340-6245 (ISSN-L)
- 2567-689X
- OpenAlex
- W2082315647
- Cited by
- 91
- References
- 28
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 4 · 2021: 6 · 2020: 7 · 2019: 6 · 2018: 7 · 2017: 8 · 2016: 8 · 2015: 5 · 2014: 4 · 2013: 7 · 2012: 9
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thrombosis and Haemostasis (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- Netherlands Heart Foundation (NHF-99-172)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Environmental Valuation
- Keywords
- venous thromboembolism, vitamin K antagonists, health state valuation, treatment preferences, treatment duration, post-thrombotic syndrome, major bleeding, patient heterogeneity, patient-centered care
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anticoagulants, Attitude to Health, Female, Health, Health Status Indicators, Humans, Male, Middle Aged, Quality of Life, Thromboembolism, Vitamin K, Venous Thrombosis
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