title: A clinical decision aid for the selection of antithrombotic therapy for the prevention of stroke due to atrial fibrillation.
abstract: OBJECTIVE
  The availability of new antithrombotic agents, each with a unique efficacy and bleeding profile, has introduced a considerable amount of clinical uncertainty with physicians. We have developed a clinical decision aid in order to assist clinicians in determining an optimal antithrombotic regime for the prevention of stroke in patients who are newly diagnosed with non-valvular atrial fibrillation.
  
  
  RESULTS
  The CHA(2)DS(2)-VASc and HAS-BLED scoring systems were used to assess patients' baseline risks of stroke and major bleeding, respectively. The relative risks of stroke and major bleeding for each antithrombotic agent were then used to identify the agent associated with the lowest net risk. Individual patient factors such as the treatment threshold, bleeding ratio, and cost threshold modified the recommendations in order to generate a final recommendation. By considering both patient factors and clinical research concurrently, this clinical decision aid is able to provide specific advice to clinicians regarding an optimal stroke prevention strategy. The resulting treatment recommendation tables are consistent with the recommendations of the European Society of Cardiology and Canadian Cardiovascular Society Guidelines, which can be incorporated into either a paper-based or electronic format to allow clinicians to have decision support at the point of care.
  
  
  CONCLUSIONS
  The use of a clinical decision aid that considers both patient factors and evidence-based medicine will serve to bridge the knowledge gap and provide practical guidance to clinicians in the prevention of stroke due to atrial fibrillation.
authors: Queen's University, Kingston, ON, Canada. stephenlahaye@hotmail.com
authors: Stephen Andrew
authors: SA
authors: LaHaye
authors: Sabra Lynn
authors: SL
authors: Gibbens
authors: David Gerald Andrew
authors: DG
authors: Ball
authors: Andrew George
authors: AG
authors: Day
authors: Jonas Bjerring
authors: JB
authors: Olesen
authors: Allan Cameron
authors: AC
authors: Skanes
mesh_terms: D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications* / Q000191:economics; D001562:Benzimidazoles / Q000191:economics / Q000627:therapeutic use; D000069604:Dabigatran; D003661:Decision Support Techniques; D016527:Drug Costs; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009025:Morpholines / Q000191:economics / Q000627:therapeutic use; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use; D018570:Risk Assessment; D000069552:Rivaroxaban; D020521:Stroke / Q000191:economics / Q000517:prevention & control*; D013876:Thiophenes / Q000191:economics / Q000627:therapeutic use; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D005343:Fibrinolytic Agents; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran