title: Physician's fear of anticoagulant therapy in nonvalvular atrial fibrillation.
abstract: Despite the availability of predictive tools and treatment guidelines, anticoagulant therapies are underprescribed and many patients are undertreated for conditions that predispose to thromboembolic complications, including stroke. This review explores reasons for which physicians fear that the risks of anticoagulation may be greater than the potential benefit. The results of numerous clinical trials confirm that patients benefit from judiciously managed anticoagulation and that physicians can take various approaches to minimize risk. Use of stratification scores for patient selection and accurate estimation of stroke risk may improve outcomes; bleeding risk is less important than stroke risk. Adoption of newer anticoagulants with simpler regimens may help physicians allay their fears of anticoagulant use in patients with atrial fibrillation. These fears, although not groundless, should not overtake caution and hinder the delivery of appropriate evidence-based care.
authors.affiliation: Department of Neurology, University of South Carolina School of Medicine, Columbia, South Carolina.
authors.forename: Souvik
authors.initials: S
authors.lastname: Sen
authors.forename: Katherine Willett
authors.initials: KW
authors.lastname: Dahlberg
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D005239:Fear; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants