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

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. 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. Of 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 studies; renal impairment reduced DOAC initiation, favoring warfarin in (94%). 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. This systematic review was registered as a PURE protocol (https://pureportal.strath.ac.uk/en/projects/factors-associated-with-the-prescribing-of-direct-acting-oral-ant).