Institute of Biomedicine, University of Turku, Turku, Finland.
School of Pharmacy, University of Eastern Finland, Kuopio, Finland.
Basic Clin Pharmacol Toxicol. 2019 Apr;124(4):416-422. doi: 10.1111/bcpt.13145. Epub 2018 Oct 31.
Direct oral anticoagulants provide an alternative to vitamin K antagonists for the anticoagulation therapy in atrial fibrillation (AF). The availability of several treatment options with different attributes makes shared decision-making appropriate for the choice of anticoagulation therapy. The aim of this study was to understand how physicians choose an oral anticoagulant (OAC) for patients with AF and how physicians view patients' participation in this decision. Semi-structured interviews with 17 Finnish physicians (eight general practitioners and nine specialists) working in the public sector were conducted. An interview guide on experience, prescribing and opinions about oral anticoagulants was developed based on previous literature. The data were thematically analysed using deductive and inductive approaches. Based on the interviews, patient's opinion was the most influential factor in decision-making when there were no clinical factors limiting the choice between OACs. Of patient's preferences, the most important was the attitude towards co-payments of OACs. Patients' opinions on monitoring of treatment, dosing and antidote availability were also mentioned by the interviewees. The choice of an OAC in AF was patient-centred as all interviewees expressed that patient's opinion affects the choice.
直接口服抗凝剂为房颤（AF）的抗凝治疗提供了维生素 K 拮抗剂的替代方案。由于有多种具有不同属性的治疗选择，因此共同决策适合抗凝治疗的选择。本研究旨在了解医生如何为 AF 患者选择口服抗凝剂（OAC），以及医生如何看待患者参与这一决策。对在公共部门工作的 17 名芬兰医生（8 名全科医生和 9 名专科医生）进行了半结构化访谈。根据以往的文献，制定了一份关于口服抗凝剂经验、处方和意见的访谈指南。使用演绎和归纳方法对数据进行主题分析。根据访谈，当没有临床因素限制 OAC 选择时，患者的意见是决策中最具影响力的因素。在患者的偏好中，最重要的是对 OAC 共付费用的态度。受访者还提到了对治疗监测、剂量和解毒剂可用性的患者意见。AF 中 OAC 的选择以患者为中心，因为所有受访者都表示患者的意见会影响选择。
