A scoping review of factors associated with the prescribing choice of direct oral anticoagulant drugs

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Abunimeh, Hanan and NoorSaeed, Solafa and Alkhlaifat, Rahaf and Kurdi, Amanj and Mueller, Tanja (2025) A scoping review of factors associated with the prescribing choice of direct oral anticoagulant drugs. Expert Review of Cardiovascular Therapy, 23 (8). pp. 427-445. ISSN 1744-8344 (https://doi.org/10.1080/14779072.2025.2536043)

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Abstract

Introduction With the substantial increase in direct oral anticoagulant (DOAC) usage, prescribers face complex decisions regarding the appropriate agent selection. This scoping review aimed to identify factors influencing oral anticoagulant choice in clinical practice over time. Methods Four databases (Medline, Embase, Scopus, Web of Science) were searched for quantitative observational studies on patients prescribed DOACs for any indication, focusing on factors affecting OAC choice. Studies published from January 2010 to March 2023 were included. Results Of the 4659 identified studies, 60 met selection criteria. Most (96%) examined the choice between DOACs and vitamin K antagonists (VKA); while (15%) evaluated factors affecting choice among DOACs. Age and gender were included in 77% and 70% of studies, respectively. Renal impairment (58%), heart failure (48%), previous stroke (43%), and thromboembolic risk (43%) were also commonly assessed. Older age had a significant negative association with DOAC prescribing in (50%) of the studies; renal impairment reduced DOAC initiation, favoring warfarin in (94%). Conclusions Several significant key factors were identified as being associated with OAC choice, including demographic factors such as age, and clinical factors such as kidney function, prior stroke, and other comorbidities. Significant factors in the choice among DOACs were advanced age, and renal impairment.

ORCID iDs

Abunimeh, Hanan, NoorSaeed, Solafa, Alkhlaifat, Rahaf ORCID logoORCID: https://orcid.org/0000-0002-7007-3534, Kurdi, Amanj ORCID logoORCID: https://orcid.org/0000-0001-5036-1988 and Mueller, Tanja ORCID logoORCID: https://orcid.org/0000-0002-0418-4789;
CORE (COnnecting REpositories)