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    Patient preferences for venous thromboembolism prophylaxis after injury: A discrete choice experiment

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    Author
    Haac, B.E.
    O'Hara, N.N.
    Mullins, C.D.
    Date
    2017
    Journal
    BMJ Open
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://www.doi.org/10.1136/bmjopen-2017-016676
    Abstract
    Objective Limited evidence for the optimal venous thromboembolism (VTE) prophylaxis regimen in orthopaedic trauma leads to variability in regimens. We sought to delineate patient preferences towards cost, complication profile, and administration route (oral tablet vs. subcutaneous injection). Design Discrete choice experiment (DCE). Setting Level 1 trauma center in Baltimore, USA. Participants 232 adult trauma patients (mean age 47.9 years) with pelvic or acetabular fractures or operative extremity fractures. Primary and secondary outcome measures Relative preferences and trade-off estimates for a 1% reduction in complications were estimated using multinomial logit modelling. Interaction terms were added to the model to assess heterogeneity in preferences. Results Patients preferred oral tablets over subcutaneous injections (marginal utility, 0.16; 95% CI: 0.11 - 0.21, P<0.0001). Preferences changed in favor of subcutaneous injections with an absolute risk reduction of 6.98% in bleeding, 4.53% in wound complications requiring reoperation, 1.27% in VTE, and 0.07% in death from pulmonary embolism (PE). Patient characteristics (sex, race, type of injury, time since injury) affected patient preferences (P<0.01). Conclusions Patients preferred oral prophylaxis and were most concerned about risk of death from PE. Furthermore, the findings estimated the trade-offs acceptable to patients and heterogeneity in preferences for VTE prophylaxis. Copyright Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
    Keyword
    adult surgery
    anticoagulation
    thromboembolism
    trauma management
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85027414849&doi=10.1136%2fbmjopen-2017-016676&partnerID=40&md5=cbd2046a1a8e9a2738c5ad42d829c18c; http://hdl.handle.net/10713/9929
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjopen-2017-016676
    Scopus Count
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    UMB Open Access Articles 2017

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