Informed decisions about treatment with anticoagulants

Jasper van Miert

    Research output: ThesisThesis fully internal (DIV)

    233 Downloads (Pure)


    Over 500,000 people in the Netherlands use anticoagulants to prevent blood clots (thrombosis) that can cause a stroke or pulmonary embolism.
    Over the years, more anticoagulants have become available.
    How can patients and their physicians choose the best anticoagulant?

    Vitamin K antagonists (VKAs) are anticoagulants that have been used for decades.
    The dose a patient requires varies widely.
    Anticoagulation clinics titrate the dose to maintain the blood's ability to clot (INR) within narrow margins.
    Patients whose INR is more often in range, are at lower risk for bleeding and thrombosis, and require less frequent INR monitoring.

    Newer anticoagulants, the direct oral anticoagulants (DOACs), are on average just as good as VKAs.
    The DOACs have a fixed dose and obviate monitoring of their effect.
    DOACs are advised to new patients, but 200,000 patients previously treated with VKA have switched.
    Quality of treatment with VKA can play a role in the decision to switch.
    Our research shows several methods to forecast future treatment quality.
    This allows patients and physicians to make an informed joint decision.

    Previously, we thought that patients with a high VKA treatment quality should not switch to a DOAC.
    However, our research shows they can safely switch.
    Nevertheless, some patients are ineligible to switch, e.g. because of kidney problems.
    We have investigated methods to make treatment with VKA safer and more effective.
    More precise dosing of a VKA only has a limited effect.
    However, switching to a longer-acting VKA could be a good option for many patients.
    There are steps towards personalised treatment with anticoagulants.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    • Meijer, Karina, Supervisor
    • Veeger, Nic, Co-supervisor
    Award date12-Apr-2021
    Place of Publication[Groningen]
    Publication statusPublished - 2021

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