Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Chest. 2012 Feb;141(2 Suppl):e1S-e23S. doi: 10.1378/chest.11-2290.


Background: Development of clinical practice guidelines involves making trade-offs between desirable and undesirable consequences of alternative management strategies. Although the relative value of health states to patients should provide the basis for these trade-offs, few guidelines have systematically summarized the relevant evidence. We conducted a systematic review relating to values and preferences of patients considering antithrombotic therapy.

Methods: We included studies examining patient preferences for alternative approaches to antithrombotic prophylaxis and studies that examined, in the context of antithrombotic prophylaxis or treatment, how patients value alternative health states and experiences with treatment. We conducted a systematic search and compiled structured summaries of the results. Steps in the process that involved judgment were conducted in duplicate.

Results: We identified 48 eligible studies. Sixteen dealt with atrial fibrillation, five with VTE, four with stroke or myocardial infarction prophylaxis, six with thrombolysis in acute stroke or myocardial infarction, and 17 with burden of antithrombotic treatment.

Conclusion: Patient values and preferences regarding thromboprophylaxis treatment appear to be highly variable. Participant responses may depend on their prior experience with the treatments or health outcomes considered as well as on the methods used for preference elicitation. It should be standard for clinical practice guidelines to conduct systematic reviews of patient values and preferences in the specific content area.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Atrial Fibrillation / complications
  • Atrial Fibrillation / drug therapy
  • Cost of Illness
  • Decision Making*
  • Evidence-Based Medicine*
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / prevention & control
  • Patient Participation*
  • Patient Preference*
  • Patient Satisfaction
  • Practice Guidelines as Topic*
  • Social Values*
  • Societies, Medical
  • Stroke / drug therapy
  • Stroke / prevention & control
  • Thrombolytic Therapy / adverse effects
  • Thrombosis / drug therapy*
  • Thrombosis / prevention & control*
  • United States
  • Venous Thromboembolism / drug therapy
  • Venous Thromboembolism / prevention & control


  • Fibrinolytic Agents