Anakwue Raphael, Nwagha Theresa, Ukpabi Ogba J, Obeka Ndudim, Onwubuya Emmanuel, Onwuchekwa Uwa, Azubuike Benjamin, Okoye Innocent
Department of Medicine, Pharmacology/Therapeutics, University of Nigeria, Enugu Campus, Nigeria.
Department of Haematology and Immunology, Thrombosis and Bleeding Unit, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
Ann Afr Med. 2017 Oct-Dec;16(4):164-169. doi: 10.4103/aam.aam_35_17.
Thromboembolic and hypercoagulable diseases are common life-threatening but treatable problems in hospital practice. Fortunately, anticoagulation is an efficacious management practice indicated for arterial, venous, and intracardiac thromboembolism. Clinicians in developing countries may have gaps in their knowledge of anticoagulation therapy/prophylaxis which could affect their clinical decision.
The study examined the knowledge and attitude of clinicians to anticoagulation therapy/prophylaxis in some tertiary hospitals in Nigeria.
The study was a multicenter survey. A pretested questionnaire was administered to clinicians in six tertiary hospitals in Southeast Nigeria.
A total of 528 questionnaires were returned by 419 (79.4%) residents and 109 (20.6%) consultants. We observed significant abysmal knowledge and lack of awareness of direct oral anticoagulants (DOACs) among most respondents irrespective of their job grades (P = 0.02, odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.90). Their knowledge of anti-Xa assay as laboratory monitoring tool was also significantly inadequate (P = 0.001, OR 0.23, 95% CI 0.10-0.51). On statement analysis on their attitude to anticoagulation therapy/prophylaxis, "Do you think anticoagulation therapy/prophylaxis is clinically relevant" had the highest mean of 4.60, P = 0.01, and a high degree of agreement; while "Should hospital inpatient with > 3 days admission routinely receive anticoagulation/prophylaxis?" had the lowest mean of 2.27, P = 0.02, and a low degree of agreement.
There is the need to upscale knowledge of anticoagulation agents and an attitude change to anticoagulation therapy/prophylaxis, especially on the DOACs through continuing medical education activities in emerging countries such as Nigeria.
血栓栓塞性疾病和高凝性疾病在医院临床实践中是常见的危及生命但可治疗的问题。幸运的是，抗凝治疗是针对动脉、静脉和心内血栓栓塞的一种有效治疗方法。发展中国家的临床医生在抗凝治疗/预防知识方面可能存在差距，这可能会影响他们的临床决策。
本研究调查了尼日利亚一些三级医院临床医生对抗凝治疗/预防的知识和态度。
本研究为多中心调查。对尼日利亚东南部六家三级医院的临床医生发放了经过预测试的问卷。
共回收528份问卷，其中419名（79.4%）住院医师和109名（20.6%）顾问医师回复。我们观察到，无论工作级别如何，大多数受访者对抗凝剂的知识严重匮乏，对直接口服抗凝剂（DOACs）缺乏了解（P = 0.02，比值比[OR] 0.59，95%置信区间[CI] 0.38 - 0.90）。他们将抗Xa测定作为实验室监测工具的知识也明显不足（P = 0.001，OR 0.23，95% CI 0.10 - 0.51）。在对抗凝治疗/预防态度的陈述分析中，“你认为抗凝治疗/预防在临床上是否相关”的平均得分最高，为4.60，P = 0.01，且高度认同；而“住院超过3天的患者是否应常规接受抗凝/预防治疗？”的平均得分最低，为2.27，P = 0.02，且认同度较低。
在尼日利亚等新兴国家，有必要通过继续医学教育活动，提升对抗凝药物的知识以及对抗凝治疗/预防的态度转变，尤其是关于直接口服抗凝剂方面。
