Doctors’ Adherence to the Guidelines on the Oral Anticoagulants Usage

Abstract

Aim. To study doctors’ knowledge of the clinical guidelines on the use of oral anticoagulants and identify the reasons for poor adherence.Material and methods. The results of the 218 questionnaires completed by the doctors trained in the 2018-2019 were analyzed. The questionnaire included 12 items regarding the main aspects of oral anticoagulants use. 71.6% of respondents were cardiologists, 18.8% were therapists (including general practitioners) and 9.6% were representatives of other specialties.Results. The obtained data show that therapists are worse than cardiologists aware of indications for oral anticoagulants in atrial fibrillation, and do not always correctly assess the risk of thromboembolism. Only 24.4% of therapists consider prescribing rivaroxaban in a dose of 2.5 mg 2 times a day to a patient suffering from myocardial infarction with an ST segment elevation on the electrocardiogram. One third of therapists either do not know or do not support current recommendations regarding oral anticoagulants use in paroxysmal atrial fibrillation. 65.3% cardiologists are inclined to start anticoagulant therapy only in patients at high risk for thromboembolism, while 36.6% therapists are ready to start such treatment even at moderate risk. Respondents' answers to the questionnaire demonstrate their great alertness regarding possible bleeding. Overestimation of the bleeding risk is more often among therapists than cardiologists (44.9% and 17.1%, respectively). More than one third of therapists (36.6%) are ready to recommend a reduced dose of oral anticoagulant to patients without clear reasons. Fear of bleeding has a greater influence on the decision to prescribe an anticoagulant and the choice of treatment regimen for atrial fibrillation than the desire to effectively prevent thromboembolism.Conclusion. The results of the survey show that the doctors’ adherence to the clinical guidelines’ basic principles of the use of oral anticoagulants among cardiologists is higher than that of therapists. Wherein, even among cardiologists it cannot be considered sufficient. The lack of doctors’ awareness about the identification, assessment, and modification of risk factors for bleeding was revealed.