title: [Anticoagulation in the aged patient with atrial fibrillation: What are prescribing cardiologists, geriatricians and general practitioners?].
abstract: OBJECTIVE
  To assess prescribing of anticoagulants in atrial fibrillation (AF) in the elderly, both a quantitative point of view (rate of anticoagulation) and qualitative (type of anticoagulation). Determinants of prescribing and non-prescribing were also analysed.
  
  
  METHODS
  Prospective survey of practice, based on one clinical case and questionnaire conducted in 60 practitioners (20 cardiologists [C], 20 geriatricians [G] and 20 general practitioners [GP]).
  
  
  RESULTS
  In reading the clinical case, 88.3% of physicians would have initiated a treatment; three types of treatments would have been chosen: AVK (68.3%), ODA (20.0%) and platelet antiaggregant (11.7%). Criteria taken into account to initiate anticoagulation varied according to the specialty. Cardiologists considered more the age criteria (C: 95.0%, G: 75.0%, MG: 60.0%; P<0.05), diabetes (C: 90.0%, G: 60.0%, MG: 55.0%; P<0.05), hypertension (C: 85.0%, G: 55.0%, MG: 60.0%; P<0.05) and female gender (C: 80.0%, G: 35.0%, MG: 25.0%; P<0.05). The quality of renal function was however a more secondary criteria (C: 15.0%, G: 5.0%, MG: 0.0%; P<0.05). General practitioners considered most frequently the presence of underlying heart disease (C: 35.0%, G: 5.0%, MG: 45.0%; P<0.05) as well as usual cardiovascular risk factors (overweight, dyslipidaemia; P<0.05). Risk of bleeding, however, was observed by 76.7% of physicians in the clinical situation presented (C: 70.0%, G: 75.0%, MG: 85.0%; P<0.05).
  
  
  CONCLUSIONS
  This survey confirms that the FA remains under anticoagulated in the elderly and the barriers to the prescription of oral anticoagulation are often without rational basis.
authors.affiliation: Pôle de gériatrie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
authors.forename: P
authors.initials: P
authors.lastname: Fuchs
authors.affiliation: Pôle de gériatrie, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France.
authors.forename: T
authors.initials: T
authors.lastname: Vogel
authors.affiliation: Département de médecine, service de gériatrie et de réadaptation gériatrique, centre hospitalier universitaire Vaudois (CHUV), chemin de Mont Paisible 16 (MP16/04/414), 1011 Lausanne, Suisse; Health and Wellbeing Academy, Anglia Ruskin University, CB1 1PT Cambridge, Royaume-Uni. Electronic address: Pierre-Olivier.Lang@chuv.ch.
authors.forename: P-O
authors.initials: PO
authors.lastname: Lang
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications*; D002309:Cardiology; D011307:Drug Prescriptions / Q000592:standards; D004617:Embolism / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D058006:General Practice; D005853:Geriatrics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011795:Surveys and Questionnaires
chemical_list: D000925:Anticoagulants
keywords: Anti-vitamine K; Anticoagulant oraux directs; Anticoagulants oraux; Anticoagulation therapy; Antivitamin-K; Atrial fibrillation; Fibrillation atriale; Guidelines; Oral anticoagulants; Oral direct anticoagulant; Recommandations; Traitement anticoagulant