Physicians' attitudes toward oral anticoagulants and antiplatelet agents for stroke prevention in elderly patients with atrial fibrillation
Article Abstract:
Atrial fibrillation is an abnormal, irregular heart beat that can cause the formation of blood clots in the heart. Fragments of these blood clots can break away and lodge elsewhere in the circulation, producing serious complications such as stroke. The use of the blood-thinning drug, or anticoagulant, warfarin in patients with atrial fibrillation can reduce the risk of stroke by 75 percent. In past years, the doses of warfarin were higher than those currently recommended, and posed a significant risk of bleeding. A survey was conducted to determine the attitudes of physicians toward the use of warfarin in atrial fibrillation. Of the 251 physicians who responded to the survey, 78 percent used warfarin for atrial fibrillation caused by disease of the heart valves, which is known to carry the highest risk of stroke, but only 18 percent used warfarin for atrial fibrillation of any cause. About 50 percent of these doctors avoided warfarin because of the risk of bleeding, 24 percent because they were not convinced that the drug prevented stroke, and 17 percent because they found it difficult to monitor patients on the drug. Although the evidence for the effectiveness of aspirin in preventing strokes is not as strong as that of warfarin, physicians prescribe aspirin for patients who have had transient ischemic attacks, stroke-like events that resolve in less than 24 hours. Dipyridamole, another drug with some anticlotting activity, was used by less than 25 percent of physicians. Recent studies may change the way that physicians prescribe warfarin. This new evidence suggests that the drug is more effective than previously realized in the prevention of stroke, and further, that lower doses appear to be equally effective and safer in terms of bleeding complications. The risk of stroke is sufficiently high in atrial fibrillation that physicians should reevaluate the use of warfarin. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1991
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Acquired immunodeficiency syndrome prevention: knowledge, attitudes, and practices of primary care physicians
Article Abstract:
In order to have some understanding of physicians' knowledge, attitudes, and counselling practices regarding AIDS (acquired immunodeficiency syndrome), a survey of nearly 500 primary care practitioners in New York City was conducted. The doctors questioned practiced internal medicine, obstetrics-gynecology, or family or general practice. More than 70 percent of these doctors had at some point cared for a patient with AIDS, and over 90 percent had ordered the blood test for AIDS for one of their patients. Physician knowledge about AIDS exceeded that of the general public, but some gaps in doctors' knowledge were found. Counselling patients about AIDS and its prevention was done by only 28 percent of the physicians surveyed. More than half of the doctors questioned stated that they took sexual histories from their patients, but they generally did not ask the specific questions that would point to increased risk for AIDS, such as how many sexual partners a patient might have had. Of note, the younger the physician, the more likely he was to be knowledgeable about AIDS, and the more likely he was to counsel on AIDS prevention. Interestingly, when broken down by specialty, obstetrician-gynecologists were less likely to have extensive knowledge about AIDS, but more likely to have counselled patients about its prevention. Those physicians whose attitudes toward homosexual males were most negative were also least likely to be knowledgeable about the disease. The survey suggests the need for greater education of physicians on both the disease AIDS and its prevention. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
Subject: Health
ISSN: 0003-9926
Year: 1991
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