Grant: Project Grant

Blood thinners (anticoagulants) are used to prevent and treat blood clots (thrombosis). The main side effect of blood thinners is bleeding, the majority of which is from the stomach or intestines (gastrointestinal). After bleeding, anticoagulants are stopped permanently in about half of patients even though they are still needed to prevent thrombosis. Patients who restart blood thinners seem to have less blood clotting and death, but more bleeding. No one knows when it is safe to restart anticoagulants after a gastrointestinal bleed and there is no published information about patient values and preferences about restarting blood thinners after bleeding, which is critical for shared decision-making. Our goal is to understand patient values and preferences after gastrointestinal bleeding while on anticoagulants. We will determine the issues that are important to patients when they are considering restarting anticoagulants after gastrointestinal bleeding. The results of this study will (1) help doctors make shared decisions with patients, (2) help experts make recommendations that take patient values and preferences into account, (3) help plan a definitive study to find out whether, when and how blood thinners can be restarted safely. We will start by determining the main themes of patient experiences and preferences in individual interviews. We will then use a survey method called discrete choice experiments to determine the importance of different factors that affect decisions about blood thinners. The survey will be distributed in clinics using tablet computers and online through the National Blood Clot Alliance and Thrombosis Canada. The National Blood Clot Alliance is a non-profit patient advocacy organization with more than 5,400 online support group members and a total annual website viewership of more than 3 million individuals, including nearly 180,000 Canadians.