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

Abstract

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). The objective was to describe prescribers’ experiences of using DOACs in the management of non-valvular AF, including perceptions of benefits and limitations. 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. 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. 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.

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

• Journal Article Type: Article
• Acceptance Date: Jun 8, 2020
• Online Publication Date: Jun 13, 2020
• Publication Date: Jun 30, 2020
• Deposit Date: Jul 31, 2020
• Publicly Available Date: Jul 31, 2020
• Journal: Pharmacy practice
• Print ISSN: 1885-642X
• Electronic ISSN: 1886-3655
• Publisher: Centro de Investigaciones y Publicaciones Farmaceuticas
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 2
• Article Number: 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
• Public URL: https://rgu-repository.worktribe.com/output/957746