Letters

Antithrombotic treatment for atrial fibrillation

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7211.708 (Published 11 September 1999) Cite this as: BMJ 1999;319:708

Patients must be told full details of risks of treatment

  1. Gregory Peterson, associate professor
  1. School of Pharmacy, Faculty of Health Science, University of Tasmania, GPO Box 252-26, Hobart, TAS 7001, Australia
  2. Warders Medical Centre, Tonbridge, Kent TN9 1LA
  3. Department of General Practice, Guy's, King's And St Thomas's School of Medicine, London SE11 6SP

    EDITOR—The findings of Howitt and Armstrong's study of antithrombotic treatment for atrial fibrillation in general practice—in particular that patients were unwilling to take warfarin—have uncertain clinical relevance.1 They are in contrast to those of Sudlow et al, who reported that most elderly patients with atrial fibrillation would accept treatment to prevent stroke.2

    The precise information provided to patients is critically important in influencing their beliefs. Lack of detail on the information provided about the drugs mars Howitt and Anderson's study. The authors emphasised the value of a patient centred approach in determining antithrombotic treatment in chronic atrial fibrillation and presented to patients, in pictorial fashion, the benefits (derived from clinical trials) of warfarin and aspirin. An equally important methodological issue, however, is the presentation of the risks of the treatment.

    The methods section states only that “detailed information about aspirin and warfarin treatment was given.” What exactly does this mean? If the material consisted of the typical prescribing information for warfarin or even the equally daunting consumer drug information developed by pharmaceutical companies, it is not surprising that many patients were frightened off treatment.

    Adopting a patient centred approach to therapeutic decision making requires that the potential risks of the treatment are presented in as patient friendly a manner as the possible benefits.

    Footnotes

    • a G.Peterson{at}utas.edu.au

    References

    1. 1.
    2. 2.

    Authors' reply

    1. Alistair Howitt, principal in general practice (ajhowitt{at}warders.co.uk),
    2. David Armstrong, reader in sociology as applied to medicine
    1. School of Pharmacy, Faculty of Health Science, University of Tasmania, GPO Box 252-26, Hobart, TAS 7001, Australia
    2. Warders Medical Centre, Tonbridge, Kent TN9 1LA
    3. Department of General Practice, Guy's, King's And St Thomas's School of Medicine, London SE11 6SP

      EDITOR—The interventions in the two studies (ours and that of Sudlow et al) were fundamentally different and cannot be directly compared. Sudlow et al did not give patients advice about anticoagulant treatment explicitly but asked their views on a “therapy to prevent a stroke even if it involved frequent blood tests.” In our study, patients were given explicit information about warfarin and aspirin, and 93% of patients were taking one of the treatments at the end of the study.

      Other studies have addressed the uptake of treatment with warfarin alone, without considering aspirin.1 2 In reality, patients have a choice between an effective but potentially hazardous treatment for which the evidence base is strong and another less effective but safer treatment for which trial results are less conclusive. Perhaps the fact that we gave patients this option contributed to the low uptake of warfarin in our study.

      Footnotes

      • Graphic Details of the information given to patients are available on the BMJ's website, www.bmj.com.

      References

      1. 1.
      2. 2.
      View Abstract

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