Persons with hemophilia face challenges when requiring antithrombotic therapy due to competing bleeding and thrombosis risks. The absence of robust evidence complicates clinical decision-making, relying on expert opinions and consensus. To explore the decision-making processes of physicians managing antithrombotic therapy in persons with hemophilia, identify key factors shaping clinical judgment, and develop a decision-making framework to improve patient care and research. We conducted a qualitative study grounded in constructivist methodology, recruiting seven Canadian physicians with expertise in hemophilia and/or thromboembolic disorders. Three virtual focus groups were held and analyzed using reflexive thematic analysis. Themes were developed iteratively to identify key components. Participants described five themes involving initial and continuous risk assessment of bleeding and thrombosis, selection of safe antithrombotic therapies or alternatives, and development of hemophilia-specific treatment plans. They highlighted the need for periodic reassessment of strategies and emphasized individualized, co-produced care. Each framework element encompassed multiple factors influencing decision-making toward patient-centered care. This study provides a decision-making framework to guide antithrombotic therapy in persons with hemophilia. By integrating risk assessments, individualized care, and shared decision-making, the framework addresses this high-risk context. Future research should validate the framework and incorporate patient perspectives to enhance practice.
Uminski et al. (Thu,) studied this question.