Abstract Body: Introduction: While the direct oral anticoagulants (DOACs) now represent the primary anticoagulant class for the management of venous thromboembolic disease (VTE) in the United States (U.S.), vitamin K antagonists (VKAs) continue to be used. It is unclear if this relates to social determinants of health (SDOH) and how providers address cost concerns when prescribing anticoagulation for VTE.

Hypothesis: We hypothesized that front-line prescribers would report SDOH factors as a reason for prescribing VKAs. We anticipated providers would change anticoagulants in response to cost concerns.

Methods: We developed a 35-question survey that included two open-ended questions. This was administered electronically to internal medicine, family medicine, and emergency medicine physicians between October and November 2025, leveraging Sermo’s network of verified physicians. Providers in training, employed outside the U.S., with <50% clinical effort, that did not manage VTE, and who answered the survey faster than anticipated response times were excluded.

The compensated survey asked about demographics, perspectives, and practice patterns. Open ended responses were coded with up to three codes for each question. Key themes from the open-ended responses were analyzed and descriptive statistics are reported.

Results: A total of 1,623 surveys from eligible respondents were completed (67% response rate), with codable open-ended responses provided by 1,496 respondents. Respondent characteristics and select perspectives are shown in Table 1. When surveyed about reasons for prescribing VKA, the most commonly selected (n=1,623) responses were cost/insurance (65%), patient co-morbidities (18%), and ability to monitor levels (6%).

Qualitative analysis of 464 open ended responses to the questions 1) “Recall the most recent times you have prescribed oral VKAs, please describe the reason or reasons…?” and 2) “…can you explain your strategy for dealing with anticoagulation cost concerns? Why…?” are shown in Tables 2 and 3 respectively. Coders had an inter-rater exceeding a kappa score of 0.85.

Conclusions: Beyond clinical factors, SDOH variables influence anticoagulant class prescribing for VTE and providers are inconsistent in their approaches to address cost concerns. These data highlight the need for solutions that help prescribers mitigate barriers to DOAC therapy access and to help patients receive the best anticoagulant for their clinical needs.