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A systematic review of clinicians' views and experiences of direct-acting oral anticoagulants in the management of non-valvular atrial fibrillation.

Generalova, Daria; Cunningham, Scott; Leslie, Stephen J.; Rushworth, Gordon F.; McIver, Laura; Stewart, Derek

Authors

Daria Generalova

Stephen J. Leslie

Gordon F. Rushworth

Laura McIver

Derek Stewart



Abstract

Introduction: While a plethora of systematic reviews have provided evidence of efficacy, effectiveness and safety of direct-acting oral anticoagulants (DOACs) in the management of non-valvular atrial fibrillation (AF), there has been little emphasis on clinicians' perspectives. This systematic review aimed to critically appraise, synthesise and present the available evidence of clinicians' views and experiences. Methods: Studies published in English from January 2006 to July 2017 reporting the views and/or experiences of doctors, nurses or pharmacists on any individual DOAC or as a pharmacological group were included. Studies were assessed for quality by two researchers, data extracted and findings synthesised using a narrative approach. Results: Following exclusion of duplicates, 777 titles, 394 abstracts and 196 studies were screened. Ten studies were included in the review, nine of which were quantitative (cross-sectional surveys) and one qualitative (semi-structured interviews), with marked heterogeneity in outcomes reported. Studies were conducted exclusively in Europe and the United States. In those studies reporting clinician preference, DOACs were first choice over warfarin in na{uml}ive patients, based on perceptions of evidence of effectiveness equivalent or superior to warfarin and superior safety. Other advantageous factors were in those with an unstable INR and likely to miss appointments. There were, however, concerns relating to management of over-anticoagulation and experiences of observed bleeding rates. Conclusion: There is a limited evidence base of clinicians' perspectives of DOACs, necessitating further research, particularly given the trajectory of increased use worldwide.

Citation

GENERALOVA, D., CUNNINGHAM, S., LESLIE, S.J., RUSHWORTH, G.F., MCIVER, L. and STEWART, D. 2018. A systematic review of clinicians' views and experiences of direct-acting oral anticoagulants in the management of non-valvular atrial fibrillation. British journal of clinical pharmacology [online], 84(12), pages 2692-2703. Available from: https://doi.org/10.1111/bcp.13739

Journal Article Type Article
Acceptance Date Aug 6, 2018
Online Publication Date Aug 15, 2018
Publication Date Dec 31, 2018
Deposit Date Aug 23, 2018
Publicly Available Date Aug 16, 2019
Journal British journal of clinical pharmacology
Print ISSN 0306-5251
Electronic ISSN 1365-2125
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 84
Issue 12
Pages 2692-2703
DOI https://doi.org/10.1111/bcp.13739
Keywords Prescribing; Systematic review; Arrhythmia
Public URL http://hdl.handle.net/10059/3091

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