OBJECTIVES: Antithrombotic therapy is indicated for cardiovascular disease (CVD) conditions including ischemic stroke, acute coronary syndrome (ACS), and atrial fibrillation (AF). In this study, we assessed patients who self-reported prior stroke, ACS, or AF through qualitative interviews to understand their perspectives about effects and impacts of antithrombotic therapy, and key changes in signs, symptoms, and functioning experienced with changes in antithrombotic treatments.

METHODS: Interviews were conducted with patients in the US, UK, Germany, and Japan recruited using existing databases, social networks, and clinician referral networks. Individual interviews were conducted via video conference with trained qualitative research interviewers and lasted ~90 minutes. Audio files were transcribed and coded to group concepts by similarity of theme or concept using ATLAS.ti software.

RESULTS: Of 64 patients interviewed, the average age was 60.5 years and 52% were female. Forty-six (72%) patients experienced bleeding and/or bruising associated with antithrombotic therapy (bleeding: 4; bruising: 11; both: 31). Twenty-seven (59%) patients who experienced bleeding/bruising indicated that their signs and symptoms changed as their antithrombotic treatment changed. Negative changes included excessive bruising, prolonged bleeding from cuts and lab work, nosebleeds, emotional burden, changes in daily activities to avoid bleeding, fatigue, weakness, muscle soreness, nausea, and lightheadedness. Positive changes included reduced signs and symptoms, greater security that risk for CVD events was reduced, and, for some, feeling better from improved blood flow. Both negative and positive changes were described relative to changes in antithrombotic therapy and prescribed medications.

CONCLUSIONS: Most patients attribute antithrombotic treatment change to modifications in their treatment experience; assessment tools must be appropriate to ensure that relevant changes in bleeding and bruising associated with antithrombotic treatments can be adequately assessed to inform treatment-related benefit/risk.