Peterson G M, Boom K, Jackson S L, Vial J H
are important strategies for targeting barriers to the use of anticoagulation for stroke prevention.
Intern Med J. 2002 Jan-Feb;32(1-2):15-23.
To assess the attitudes of Australian doctors towards the use of antithrombotic drug therapy for stroke prevention in patients with non-valvular atrial fibrillation (AF), and investigate the barriers to prescribing warfarin.
A postal survey was undertaken among approximately 10% of all registered general practitioners (GPs), cardiologists and physicians in Australia. The anonymous questionnaire used case scenarios to assess doctors' knowledge of current guidelines for the therapeutic management of AF and sought opinions on potential barriers to the use of anticoagulation.
Completed questionnaires were received from 711 doctors (30% response rate). The GPs performed better than the cardiologists and other specialists in estimating the risk of stroke in case scenarios. However, the cardiologists were more likely to select the recommended treatment, with GPs being more hesitant to use anticoagulation and tending to underestimate its reported benefit for stroke prevention in non-valvular AF. The GPs were also more likely to overestimate the reported risk of major bleeds with warfarin. In contrast, over one-third of the cardiologists went as far as to give warfarin to a low-risk patient and they were more likely to overestimate the reported benefit of aspirin and warfarin in AF. Only half the doctors correctly classified a patient without a previous stroke (but with other risk factors) as being at high risk. Increased experience as a registered medical practitioner was generally related to a poorer performance on classifying patients according to the risk of stroke. The principal barriers to the use of anticoagulation were nominated as: (i) active gastrointestinal bleeding, (ii) previous intracranial haemorrhage, (iii) alcoholism, (iv) a history of daily falls, (v) liver disease, (vi) severe anaemia and (vii) concurrent use of non-steroidal anti-inflammatory drugs.
There is scope for improvement in doctors' knowledge about the appropriate use of antithrombotic drug therapy in non-valvular AF and awareness of the results of recent clinical trials. Compilation and dissemination of clear guidelines and focused education on some of the other risk factors (apart from previous stroke or transient ischaemic attacks) in patients with non-valvular
评估澳大利亚医生对非瓣膜性心房颤动（AF）患者使用抗血栓药物预防中风的态度，并调查开具华法林的障碍。
对澳大利亚约10%的注册全科医生（GP）、心脏病专家和内科医生进行了邮寄调查。匿名问卷使用病例场景来评估医生对AF治疗管理当前指南的了解，并征求他们对抗凝使用潜在障碍的意见。
收到了711名医生填写的问卷（回复率为30%）。在病例场景中估计中风风险时，全科医生的表现优于心脏病专家和其他专科医生。然而，心脏病专家更有可能选择推荐的治疗方法，全科医生在使用抗凝药物时更为犹豫，并且往往低估其对非瓣膜性AF预防中风的报道益处。全科医生也更有可能高估华法林报道的大出血风险。相比之下，超过三分之一的心脏病专家甚至会给低风险患者使用华法林，并且他们更有可能高估阿司匹林和华法林在AF中的报道益处。只有一半的医生正确地将一名既往无中风（但有其他风险因素）的患者归类为高风险。作为注册医生经验的增加通常与根据中风风险对患者进行分类的表现较差有关。使用抗凝药物的主要障碍被认为是：（i）活动性胃肠道出血，（ii）既往颅内出血，（iii）酗酒，（iv）每日跌倒史，（v）肝病，（vi）严重贫血，以及（vii）同时使用非甾体抗炎药。
医生在非瓣膜性AF中对抗血栓药物治疗的合理使用知识以及对近期临床试验结果的认识有待提高。编制并传播明确的指南，并针对非瓣膜性患者的一些其他风险因素（除既往中风或短暂性脑缺血发作外）进行重点教育。
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