Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD, Australia.
Evidence Based Practice Professorial Unit, Gold Coast University Hospital, Southport, QLD, Australia.
Glob Heart. 2022 Aug 12;17(1):55. doi: 10.5334/gh.1142. eCollection 2022.
Thromboembolic events are a common risk in adults with atrial fibrillation, those with previous cerebrovascular accidents and undergoing emergency or elective surgeries. The widespread availability of antithrombotic agents and differing guidelines contribute to practice variations and increased risk of complications and deaths. The objective of this review was to investigate the extent of overuse and underuse of antithrombotics for primary or secondary prevention as measured by deviation from prescribing guideline recommendations. We conducted a systematic review of Medline and EMBASE for quantitative articles published between 2000 and 2021 and used a modified version of the Hoy's risk of bias assessment tool. Here we report evidence from the past decade about wide practice variations in hospitals and primary care, and discuss clinician and patient-driven determinants of non-adherence to guidelines. Finally, we summarise implications for practice, identify enhanced ways of measuring overuse and underuse, and propose potential solutions to the measurement challenges.
血栓栓塞事件是心房颤动、既往有脑血管意外和接受紧急或择期手术的成年人的常见风险。抗血栓药物的广泛应用和不同的指南导致了实践中的差异，并增加了并发症和死亡的风险。本综述的目的是调查抗血栓药物的过度使用和使用不足的程度，这是通过偏离处方指南建议来衡量的。我们对 2000 年至 2021 年期间发表的定量文章进行了 Medline 和 EMBASE 的系统回顾，并使用了 Hoy 偏倚风险评估工具的修改版本。在这里，我们报告了过去十年中关于医院和初级保健中广泛的实践差异的证据，并讨论了临床医生和患者驱动的不遵守指南的决定因素。最后，我们总结了对实践的影响，确定了衡量过度使用和使用不足的改进方法，并提出了衡量挑战的潜在解决方案。
