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Prescribers’ perceptions of benefits and limitations of direct acting oral anticoagulants in non-valvular atrial fibrillation.

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

Authors

Daria Generalova

Scott Cunningham

Stephen J. Leslie

Gordon F. Rushworth

Laura McIver

Derek Stewart



Abstract

Background: There is an acknowledged lack of robust and rigorous research focusing on the perspectives of those prescribing direct acting oral anticoagulants (DOACs) for non-valvular atrial fibrillation (AF). Objective: The objective was to describe prescribers’ experiences of using DOACs in the management of non-valvular AF, including perceptions of benefits and limitations. Methods: A cross-sectional survey of prescribers in a remote and rural area of Scotland. Among other items, the questionnaire invited free-text description of positive and negative experiences of DOACs, and benefits and limitations. Responses were independently analysed by two researchers using a summative content analysis approach. This involved counting and comparison, via keywords and content, followed by interpretation and coding of the underlying context into themes. Results: One hundred and fifty-four responses were received, 120 (77.9%) from physicians, 18 (11.7%) from nurse prescribers and 10 (6.4%) from pharmacist prescribers (6 unidentified professions). Not having to monitor INR was the most cited benefit, particularly for prescribers and patients in remote and rural settings, followed by potentially improved patient adherence. These benefits were reflected in respondents’ descriptions of positive experiences and patient feedback. The main limitations were the lack of reversal agents, cost and inability to monitor anticoagulation status. Many described their experiences of adverse effects of DOACs including fatal and non-fatal bleeding, and upper gastrointestinal disturbances. Conclusions: While prescribers have positive experiences and perceive benefits of DOACs, issues such as adverse effects and inability to monitor anticoagulation status merit further monitoring and investigation. These issues are particularly relevant given the trajectory of increased prescribing of DOACs.

Journal Article Type Article
Publication Date Jun 30, 2020
Journal Pharmacy practice
Print ISSN 1886-3655
Electronic ISSN 1885-642X
Publisher Centro de Investigaciones y Publicaciones Farmaceuticas
Peer Reviewed Peer Reviewed
Volume 18
Issue 2
Article Number 1936
Institution Citation GENERALOVA, D., CUNNINGHAM, S., LESLIE, S.J., RUSHWORTH, G.F., MCIVER, L. and STEWART, D. 2020. Prescribers' perceptions of benefits and limitations of direct acting oral anticoagulants in non-valvular atrial fibrillation. Pharmacy practice [online], 18(2), article ID 1936. Available from: https://doi.org/10.18549/PharmPract.2020.2.1936
DOI https://doi.org/10.18549/PharmPract.2020.2.1936
Keywords Attitude of health personnel; Atrial fibrillation; Factor xa inhibitors; Drug prescriptions; Health knowledge; Attitudes; Practice; Cross-sectional studies; Scotland

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