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).

随着直接口服抗凝药（direct oral anticoagulant, DOAC）使用量的大幅攀升，处方医师面临着合理选择抗凝药物的复杂决策。本范围综述旨在梳理随时间推移，临床实践中影响口服抗凝药选择的各类因素。研究检索了Medline、Embase、Scopus、Web of Science共4个数据库，纳入针对任何适应证下接受DOAC治疗的患者开展的定量观察性研究，聚焦于影响口服抗凝药（oral anticoagulant, OAC）选择的相关因素。研究纳入2010年1月至2023年3月发表的相关文献。在检索得到的4659项研究中，共计60项符合纳入标准。其中绝大多数（96%）研究探讨了DOAC与维生素K拮抗剂（vitamin K antagonists, VKA）之间的用药选择；另有15%的研究评估了DOAC类药物内部的选择影响因素。年龄与性别分别被77%、70%的研究纳入考察维度。肾功能损害（58%）、心力衰竭（48%）、既往卒中史（43%）以及血栓栓塞风险（43%）同样属于常见的评估指标。50%的研究显示，高龄与DOAC处方存在显著负相关关系；肾功能损害会降低DOAC的初始用药概率，94%的研究均表明该因素会促使临床医师选择华法林。本研究确定了多项与OAC选择相关的关键显著影响因素，包括年龄等人口统计学特征，以及肾功能、既往卒中史与其他合并症等临床因素。而影响DOAC类药物内部选择的显著因素则包括高龄与肾功能损害。本系统综述已以PURE方案完成注册（https://pureportal.strath.ac.uk/en/projects/factors-associated-with-the-prescribing-of-direct-acting-oral-ant）。