Perception of physicians on factors that influence the choice of a dicoumarin or a new oral anticoagulant in patients with non-valvular atrial fibrillation
Por:
Anguita-Sanchez, M, Marco P, Alonso-Moreno, F, Arribas-Ynsaurriaga, F, Gallego-Cullere, J, Honorato-Perez, J, Suarez-Fernandez, C and Estudio ACAD
Publicada:
1 oct 2016
Resumen:
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 Workmat (TM) 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. (C) 2015 Elsevier Espana, S.L.U.
Filiaciones:
Anguita-Sanchez, M:
Hosp Univ Reina Sofia, Cordoba, Spain
Marco P:
Hosp Gen Alicante, Alicante, Spain
Alonso-Moreno, F:
Ctr Salud Silleria, Toledo, Spain
Arribas-Ynsaurriaga, F:
Hosp Univ 12 Octubre, Madrid, Spain
Gallego-Cullere, J:
Hosp Navarra, Pamplona, Spain
Honorato-Perez, J:
Univ Navarra, Pamplona, Spain
Suarez-Fernandez, C:
Hosp Univ La Princesa, Madrid, Spain
Open Access
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