Academic Unit of Primary Medical Care, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, S5 7AU, UK.
ScHARR, University of Sheffield, Sheffield, S1 4DA, UK.
BMC Fam Pract. 2021 Dec 22;22(1):254. doi: 10.1186/s12875-021-01590-x.
Atrial fibrillation (AF) increases the risk of developing a stroke by 20%. AF related strokes are associated with greater morbidity. Historically, warfarin was the anticoagulant of choice for stroke prevention in patients with AF but lately patients are being switched or started on direct oral anticoagulants (DOACs). DOACs are promoted as safer alternatives to warfarin and it is expected that they will be associated with fewer challenges both for patients and healthcare professionals. This systematic narrative review aimed to explore perspectives of patients and professionals on medicines optimisation of oral anticoagulation with vitamin K antagonists and DOACs in atrial fibrillation.
Prospero registration CRD42018091591. Systematic searches undertaken of research studies (qualitative and quantitative), published February 2018 to November 2020 from several databases (Web of Science, Scopus, Medline Via Ovid, CINHAL via Ebsco, and PubMED via NCBI) following PRISMA methodology. Data were organised using Covidence software. Two reviewers independently assessed the quality of the included studies and synthesized the findings (thematic analysis approach).
Thirty-four studies were included. Studies were critically appraised using established critical appraisal tools (Qualsyst) and a risk of bias was assigned. Clinicians considered old age and the associated complexities such as co-morbidities and the increased potential for bleeding as potential barriers to optimising anticoagulation. Whereas patients' health and medication beliefs influenced adherence. Notably, structured patient support was important in enhancing safety and effective anticoagulation. For both patients and clinicians, confidence and experience of safe anticoagulation was influenced by the presence of co-morbidities, poor knowledge and understanding of AF and the purpose of anticoagulation.
Age, complex multimorbidity and polypharmacy influence prescribing, with DOACs being perceived to be safer than warfarin. This systematic narrative review suggests that interventions are needed to support patient self-management. There are residual anxieties associated with long term anticoagulation in the context of complexities.
Not applicable.
心房颤动 (AF) 使中风风险增加 20%。AF 相关中风与更高的发病率相关。历史上，华法林是 AF 患者预防中风的首选抗凝剂，但最近患者开始或改用直接口服抗凝剂 (DOAC)。DOAC 被推广为华法林更安全的替代品，预计它们将为患者和医疗保健专业人员带来更少的挑战。本系统叙述性综述旨在探讨患者和专业人员对维生素 K 拮抗剂和 DOAC 在心房颤动中的口服抗凝药物优化的看法。
Prospéro 注册 CRD42018091591。按照 PRISMA 方法，从多个数据库（Web of Science、Scopus、Medline Via Ovid、CINHAL via Ebsco 和 PubMED via NCBI）进行了研究（定性和定量）的系统搜索，搜索时间为 2018 年 2 月至 2020 年 11 月。使用 Covidence 软件组织数据。两名审查员独立评估纳入研究的质量，并综合研究结果（主题分析方法）。
纳入 34 项研究。使用既定的批判性评估工具（Qualsyst）对研究进行批判性评估，并分配了偏倚风险。临床医生认为年龄较大以及相关的复杂性，如合并症和增加的出血潜力，是优化抗凝的潜在障碍。而患者的健康和药物信念则影响依从性。值得注意的是，结构化的患者支持对于增强安全性和有效的抗凝至关重要。对于患者和临床医生来说，对安全抗凝的信心和经验受到合并症的影响、对 AF 和抗凝目的的知识和理解不足。
年龄、复杂的多种合并症和多药治疗会影响处方，DOAC 被认为比华法林更安全。本系统叙述性综述表明，需要干预措施来支持患者的自我管理。在复杂情况下，长期抗凝仍存在残余焦虑。
不适用。
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