BMJ  2006;332:303-304 (4 February), doi:10.1136/bmj.332.7536.303-b

Letter

Barriers to using warfarin in non-valvular atrial fibrillation

The first 150 words of the full text of this article appear below.

EDITOR—Anticoagulation is underused in the treatment of non-valvular atrial fibrillation. Choudhry et al show that adverse outcomes from anticoagulation have greater influence on its management than occurrences of avoidable ischaemic stroke.1 They speculate that this result arises from undue fear or concern about adverse consequences of anticoagulation.

We are conducting a representative national survey of 1000 Australian general practitioners, addressing how fear of anticoagulation affects management of non-valvular atrial fibrillation. Our preliminary findings indicate that aversion to the risk of intracranial haemorrhage is substantial. Doctors are overly cautious in prescribing anticoagulation where there is a perceived risk of major and even minor bleeding even when the benefits of anticoagulation outweigh the risks.

In 207 early responses, 95 doctors reported the experience of an ischaemic stroke in their patients with non-valvular atrial fibrillation without anticoagulation. Only 27 reported experiencing an intracranial haemorrhage in such patients receiving anticoagulants. Over half . . . [Full text of this article]

Melina Gattellari, research fellow

General Practice Unit, School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2052, Australia Melina.Gattellari@sswahs.nsw.gov.au

Nicholas A Zwar, director

General Practice Unit, School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW 2052, Australia

John M Worthington, senior staff specialist in neurology

Liverpool Health Service. Locked Bag 7017, Liverpool, NSW 1871

Sandy Middleton, professor of nursing

School of Nursing (NSW), ACU National, PO Box 968, North Sydney, NSW 2059


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Relevant Article

Impact of adverse events on prescribing warfarin in patients with atrial fibrillation: matched pair analysis
Niteesh K Choudhry, Geoffrey M Anderson, Andreas Laupacis, Dennis Ross-Degnan, Sharon-Lise T Normand, and Stephen B Soumerai
BMJ 2006 332: 141-145. [Abstract] [Full Text] [PDF]

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