Department of Internal Diseases, Medical University of Sofia, 1431 Sofia, Bulgaria.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Medicina (Kaunas). 2019 Jun 26;55(7):313. doi: 10.3390/medicina55070313.
: Oral anticoagulation (OAC) is widely used in daily clinical practice worldwide for various indications. We aimed to explore the perception of Bulgarian clinicians about their patients' attitude and knowledge of long-term OAC, prescribed for atrial fibrillation (AF) and/or known deep venous thrombosis (DVT)/pulmonary embolism (PE). : We performed a cross-sectional study that involved 226 specialists: 187 (82.7%) cardiologists, 23 (10.2%) neurologists, and 16 (7.1%) vascular surgeons. They filled in a questionnaire, specially designed for our study, answering various questions regarding OAC treatment in their daily clinical practice. The mean prescription rate of OACs in AF patients was 80.3% and in DVT/PE-88.6%. One hundred and eighty-seven (82.7%) of the participants stated they see their patients on OAC at least once per month. According to more than one-third of the inquired clinicians, the patients did not understand well enough the provided information concerning net clinical benefit of OAC treatment. About 68% of the clinicians declared that their patients would prefer a "mutual" approach, discussing with the physician the OAC options and taking together the final decision, whereas according to 43 (19.0%), the patients preferred the physician to take a decision for them. Patients' OAC treatment had been interrupted at least once within the last year due to a physician's decision by 178 (78.8%) of the participants and the most common reason was elective surgery. The most influential factors for a patient's choice of OAC were the need of a specific diet to be kept, intake frequency, and possible adverse reactions. : Our results suggest that a clinician's continuous medical education, shared decision-making, and appropriate local strategies for improved awareness of AF/DVT/PE patients are key factors for improvement of OAC management.
：口服抗凝剂（OAC）在全球范围内广泛用于各种适应症的日常临床实践。我们旨在探讨保加利亚临床医生对其患者对长期 OAC 的态度和知识的看法，这些患者被处方用于治疗心房颤动（AF）和/或已知的深静脉血栓形成（DVT）/肺栓塞（PE）。：我们进行了一项横断面研究，涉及 226 名专家：187 名（82.7%）心脏病专家、23 名（10.2%）神经科医生和 16 名（7.1%）血管外科医生。他们填写了一份专门为我们的研究设计的问卷，回答了他们在日常临床实践中关于 OAC 治疗的各种问题。AF 患者的 OAC 处方率平均为 80.3%，DVT/PE 为 88.6%。187 名（82.7%）参与者表示，他们每月至少会看到服用 OAC 的患者一次。根据三分之一以上的调查临床医生的说法，患者对 OAC 治疗的净临床获益提供的信息理解不够充分。大约 68%的临床医生表示，他们的患者希望采用“共同”方法，与医生讨论 OAC 选择，并共同做出最终决定，而根据 43 名（19.0%）医生的说法，患者希望医生为他们做出决定。由于医生的决定，在过去一年中，178 名（78.8%）参与者的患者至少中断过一次 OAC 治疗，最常见的原因是择期手术。影响患者选择 OAC 的最重要因素是需要保持特定的饮食、摄入频率和可能的不良反应。：我们的结果表明，临床医生的持续医学教育、共同决策以及改善 AF/DVT/PE 患者意识的适当地方策略是改善 OAC 管理的关键因素。
