The Use of Antithrombotic Therapies in the Prevention and Treatment of Arterial and Venous Thrombosis

Abstract

Arterial and venous thrombosis are serious health threats. Patients with atrial fibrillation (AF), acute coronary syndromes (ACS), and venous thromboembolism (VTE) can reduce their risk of thrombosis through proper anticoagulation. Multiple evidence-based guidelines exist regarding the proper use of antithrombotic therapy, yet previous studies have shown the prevalence of inconsistent practices with respect to guideline recommendations. Here, we describe a survey of 647 practicing physicians and their current beliefs, behaviors, and knowledge surrounding the use of antithrombotic therapies in the treatment of their patients with AF, ACS, and VTE. Results show that while most physicians are confident in their abilities to treat patients with these conditions, specific knowledge of guideline recommendations for the optimal use of antithrombotic agents use is low. In addition, physician concerns over bleeding risks and complicated monitoring procedures associated with antithrombotic use were reported as barriers to their use in patients. Survey results also demonstrated that physicians have little knowledge of investigational antithrombotic agents, but would like education about them. These data suggest a need for education on guideline recommendations regarding the appropriate use of current antithrombotic therapies, as well as a need for information on the potential benefits and limitations of investigational drugs that may be used in the future to manage thrombosis in patients with AF, ACS, and VTE.

Exploration of adherence and patient experiences with DOACs one year after switching from vitamin-K antagonists- insights from the switching study

“…There is therefore a pressing need that primary care clinicians become upskilled with respect to DOACs. Research demonstrates that both primary and secondary care clinicians were unable to recognise DOACs as anticoagulants or identify risks associated with them [49,50]. Furthermore, in secondary care, drug related problems with DOACs have been found to be significantly high, a key factor being limited knowledge amongst clinicians [51].…”

Transitions of care in anticoagulated patients

“…Within health care systems, poor communication between hospitalists and primary care providers at the time of discharge is a common problem 5,40. Among physicians, inaccurate perceptions of benefit to risk,44 inadequate knowledge of guideline recommendations,45 and reluctance to prescribe anticoagulation in patients with a history of minor bleeding within the previous three months or severe bleeding more than three months previously46 may all contribute to underuse of anticoagulation. Among patients, lack of adherence with medication after discharge,1,47,48 unwillingness to undergo repeated testing,46 and inadequate knowledge about the risk of thromboembolism and the efficacy of anticoagulation49 are documented reasons for unsafe or ineffective anticoagulation.…”

Virtual Patient Simulation in Continuing Education: Improving the Use of Guideline-Directed Care in Venous Thromboembolism Treatment

“…Among these gaps, physicians who care for patients with VTE lack confidence in selecting appropriate anticoagulation therapy based on a patient’s risk for PE and incorporating NOACs into treatment strategies to optimise patient outcomes [ 2–5 ]. Second, physicians have misperceptions regarding the need to monitor adherence in patients who are using NOACs [ 3 , 6 ].…”