Comparing patient and physician risk tolerance for bleeding events associated with anticoagulants in atrial fibrillation—evidence from the United States and Japan
Atrial fibrillation (AF) is a factor in the development of thrombi that can lead to ischemic strokes. Anticoagulants are crucial in preventing strokes among patients with AF but are associated with bleeding risks. Recent studies have shown that despite anticoagulants’ efficacy in stroke prevention, many patients with AF receive subtherapeutic levels of anticoagulation because of concerns about bleeding. Of particular interest is to quantify the perceived relative importance of treatment-related benefits and risks and how these perceptions vary between patients and physicians in different countries.
Patients’ and physicians’ preferences were elicited using a discrete-choice experiment. We evaluated disagreements in preferences for the benefits and risks of anticoagulants.
A total of 186 patients with AF and 107 physicians in the United States completed the survey. In Japan, 152 patients and 164 physicians completed the same survey. Japanese patients were relatively less averse than US patients to bleeding risks. Physicians in both countries did not distinguish between nondisabling and disabling strokes. US patients were less tolerant than physicians of nonmajor clinically relevant bleeding risk when this risk was a consequence of preventing nondisabling strokes. Japanese patients were generally more tolerant than physicians of bleeding risks when the risks were consequences of preventing both nondisabling and disabling strokes.
Overall, preferences for anticoagulant benefits and risks were not statistically different between patients and physicians in the United States, nor were there differences in preferences for different stroke risks between physicians in the United States and Japan; however, preferences were different between patients and physicians in Japan.