title: [Perception of physicians on factors that influence the choice of a dicoumarin or a new oral anticoagulant in patients with non-valvular atrial fibrillation].
abstract: OBJECTIVE
  Recent studies have demonstrated the efficacy and safety of new oral anticoagulant drugs for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. Our aim was to evaluate the factors that can influence physicians in their choice between a classic and a new anticoagulant in these patients.
  
  
  METHODS
  Several variables of interest were discussed and analysed using a WorkmatTMmethodology.
  Six regional meetings were held in Spain (East, Catalonia, Andalusia-Extremadura, Madrid, North-east, and North of Spain).
  
  
  METHODS
  Meetings were attended by 39 specialists (cardiologists, neurologists, haematologists, internists, and emergency and Primary Care physicians).
  
  
  METHODS
  Each participant graded their level of agreement, with a score from 1 to 10, on every analysed variable.
  
  
  RESULTS
  A new anticoagulant drug was preferred in patients with previous failure of dicoumarin therapy (9.7±0.5), high haemorrhagic risk (8.7±1), prior bleeding (7.8±1.5), and high thrombotic risk (7.7±1.2). Dicoumarins were preferred in cases of severe (1.2±0.4) or moderate (4.2±2.5) kidney failure, good control with dicoumarins (2.3±1.5), cognitive impairment (3.2±3), and low haemorrhagic risk (4.3±3). Age, sex, weight, cost of drug, polymedication, and low thrombotic risk achieved intermediate scores. There were no differences between the different specialists or Spanish regions.
  
  
  CONCLUSIONS
  The presence of a high thrombotic or haemorrhagic risk and the failure of previous dicoumarin therapy lead to choosing a new oral anticoagulant in patients with non-valvular atrial fibrillation, while kidney failure, cognitive impairment, good control with dicoumarins, and a low bleeding risk predispose to selecting a classic dicoumarin anticoagulant.
authors.affiliation: Hospital Universitario Reina Sofía, Córdoba, España. Electronic address: manuelp.anguita.sspa@juntadeandalucia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita-Sánchez
authors.affiliation: Hospital General de Alicante, Alicante, España.
authors.forename: Pascual
authors.initials: P
authors.lastname: Marco-Vera
authors.affiliation: Centro de Salud Sillería, Toledo, España.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Alonso-Moreno
authors.affiliation: Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: Arribas-Ynsaurriaga
authors.affiliation: Hospital de Navarra, Pamplona, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: Gállego-Culleré
authors.affiliation: Universidad de Navarra, Pamplona, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Honorato-Pérez
authors.affiliation: Hospital Universitario de La Princesa, Madrid, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Suárez-Fernández
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001728:Dicumarol / Q000627:therapeutic use*; D006801:Humans; D010818:Practice Patterns, Physicians'; D013030:Spain; D020521:Stroke; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D001728:Dicumarol
keywords: Anticoagulantes orales; Anticoagulants; Atrial fibrillation; Embolia; Embolisms; Fibrilación auricular