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Am J Med Qual. 2016 Jan-Feb;31(1):38-46. doi: 10.1177/1062860614547363. Epub 2014 Aug 12.

The Educational Needs of Clinicians Regarding Anticoagulation Therapy for Prevention of Thromboembolism and Stroke in Patients With Atrial Fibrillation.

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CE Outcomes, Birmingham, AL.
CE Outcomes, Birmingham, AL


The objective is to identify practice patterns and attitudes of and barriers faced by US physicians assessing thromboembolism/stroke risk and managing anticoagulation in atrial fibrillation (AF) to determine educational needs. Case-based surveys were used to assess practice patterns, guideline use, barriers, and attitudes; 51 cardiologists and 50 primary care physicians (PCPs) were surveyed. Most cardiologists use validated risk scoring systems to assess thromboembolism/stroke risk, and more than half of PCPs use clinical experience. Assessment of bleeding risk varied; more than half of respondents rely on clinical judgment or patient bleeding history. The most commonly used prophylactic agents are warfarin/another vitamin K antagonist (PCPs) or antiplatelet agents (cardiologists). Newer anticoagulants are used less frequently. Bleeding risk, need for frequent monitoring (vitamin K antagonists), and medication costs were the most significant barriers. Cardiologists and PCPs could benefit from education on validated scoring systems to assess risk of thromboembolism/stroke and bleeding in AF, on newly released AF guidelines, and on newer anticoagulants.


anticoagulation therapy; atrial fibrillation; physician education; practice gaps; stroke; thromboembolism; warfarin

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