Perception of physicians on factors that influence the choice of a dicoumarin or a new oral anticoagulant in patients with non-valvular atrial fibrillation
Aims Recent studies have demonstrated the efficacy and safety of new oral anticoagulant drugs for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. Our aim was to evaluate the factors that can influence physicians in their choice between a classic and a new a...
| Autores: | , , , , , , , |
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| Tipo de recurso: | artículo |
| Fecha de publicación: | 2016 |
| País: | España |
| Institución: | Universidad Autónoma de Madrid |
| Repositorio: | Biblos-e Archivo. Repositorio Institucional de la UAM |
| Idioma: | español |
| OAI Identifier: | oai:repositorio.uam.es:10486/678043 |
| Acceso en línea: | http://hdl.handle.net/10486/678043 https://dx.doi.org/10.1016/j.aprim.2015.11.004 |
| Access Level: | acceso abierto |
| Palabra clave: | Anticoagulants Atrial fibrillation Embolisms Medicina |
| Sumario: | Aims Recent studies have demonstrated the efficacy and safety of new oral anticoagulant drugs for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. Our aim was to evaluate the factors that can influence physicians in their choice between a classic and a new anticoagulant in these patients. Design Several variables of interest were discussed and analysed using a WorkmatTM methodology. Sites Six regional meetings were held in Spain (East, Catalonia, Andalusia-Extremadura, Madrid, North-east, and North of Spain). Participants Meetings were attended by 39 specialists (cardiologists, neurologists, haematologists, internists, and emergency and Primary Care physicians). Measurements Each participant graded their level of agreement, with a score from 1 to 10, on every analysed variable. Results A new anticoagulant drug was preferred in patients with previous failure of dicoumarin therapy (9.7 ± 0.5), high haemorrhagic risk (8.7 ± 1), prior bleeding (7.8 ± 1.5), and high thrombotic risk (7.7 ± 1.2). Dicoumarins were preferred in cases of severe (1.2 ± 0.4) or moderate (4.2 ± 2.5) kidney failure, good control with dicoumarins (2.3 ± 1.5), cognitive impairment (3.2 ± 3), and low haemorrhagic risk (4.3 ± 3). Age, sex, weight, cost of drug, polymedication, and low thrombotic risk achieved intermediate scores. There were no differences between the different specialists or Spanish regions. Conclusions The presence of a high thrombotic or haemorrhagic risk and the failure of previous dicoumarin therapy lead to choosing a new oral anticoagulant in patients with non-valvular atrial fibrillation, while kidney failure, cognitive impairment, good control with dicoumarins, and a low bleeding risk predispose to selecting a classic dicoumarin anticoagulant. |
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