A survey of 251 physicians found hesitancy to prescribe oral anticoagulants for elderly patients with atrial fibrillation, with 51.4% believing the hemorrhage risk outweighs the benefits.
Cross-Sectional (n=251)
Yes
What are physicians' attitudes toward using oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation?
In 1991, physicians were hesitant to prescribe warfarin or aspirin for stroke prevention in elderly patients with atrial fibrillation unless an ischemic event had already occurred or mitral valve disease was present.
The use of oral anticoagulants and antiplatelet agents for the prevention of strokes in elderly patients with atrial fibrillation is controversial. Recent studies suggest that warfarin and aspirin can be safe and effective in selected patients. To determine attitudes toward this subject, we sent a questionnaire to 480 attending physicians at two major university-affiliated medical centers. Among the 251 responses (52.3%), 46 respondents (18.3%) used warfarin in atrial fibrillation of any cause, 175 (69.7%) used it in atrial fibrillation with transient ischemic attacks, 161 (64.1%) used it in patients with cerebrovascular accidents, and 196 (78.0%) used it in patients with mitral valve disease. One hundred twenty-nine (51.4%) believed that the risk of hemorrhage associated with warfarin outweighs the benefit, 61 (24.3%) were not convinced that warfarin prevents strokes in atrial fibrillation, and 42 (16.7%) believed it was difficult to monitor prothrombin time in the elderly because of poor compliance. Aspirin was used by 91 physicians (36.2%) in atrial fibrillation of any cause, 161 (64.1%) in patients with transient ischemic attacks, 140 (55.7%) in patients with cerebrovascular accidents, and 48 (19.1%) when patients were in sinus rhythm. We concluded that physicians are still hesitant to use oral anticoagulants and antiplatelet agents for the prevention of strokes in their elderly patients with atrial fibrillation. These agents are used most frequently after an ischemic episode (transient ischemic attack or cerebrovascular accident) has occurred or in patients with mitral valve disease. (Arch Intern Med. 1991;151:1950-1953)
M. Kutner (Tue,) conducted a cross-sectional in Atrial fibrillation (physician attitudes toward stroke prevention) (n=251). Oral anticoagulants (warfarin) and antiplatelet agents (aspirin) was evaluated on Physician reported use and attitudes toward warfarin and aspirin. A survey of 251 physicians found hesitancy to prescribe oral anticoagulants for elderly patients with atrial fibrillation, with 51.4% believing the hemorrhage risk outweighs the benefits.