Non-adherence to thromboprophylaxis prescribing in general practice – the views of GPs

Last year, I conducted a series of interviews with GPs in order to understand their experiences with anticoagulation management in patients with atrial fibrillation (AF). It is well known that AF is the most common arrhythmia seen in Australian general practice, and that the use of anticoagulants is a well-established intervention to reduce the risk of thromboembolism. This is reflected in the 2018 National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand AF guidelines. 

As such, I wanted to know more about GPs’ experiences with anticoagulation, and any barriers they may have with initiating anticoagulation. Below is what I found out from the research study: 

• Clinical practice guidelines, including the AF guidelines above, were not the primary sources of information on thromboprophylaxis in AF. Clinical guidelines were regarded as bulky and time consuming, and focus on single disease conditions, making it challenging to readily apply them.
• Instead, educational activities and concise resources such as journal articles and guideline summary documents were regarded as more useful means of keeping up to date with current recommendations.
• Balancing the thromboprophylactic benefits of oral anticoagulants with their bleeding risk was a major challenge in prescribing decisions.
• When compared to using formal stroke risk assessment tools like the CHA2DS2-VA, a major gap existed in applying formal bleeding risk assessment tools e.g. HAS-BLED. Instead, bleeding risk assessment was mainly done based on clinical assessment.
• In terms of bleeding risk, aspirin was seen as a safer option to oral anticoagulants by some GPs, 
• Access to a cardiologist can sometimes be challenging, especially through the public system.
• Patients’ refusal to take oral anticoagulants can sometimes affect prescribing decisions.

For more information, see the published paper 

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Eyob Gebreyohannes (PhD candidate at the University of Western Australia – Optimising anticoagulation in atrial fibrillation in Australian general practice setting.)

Email: eyob.gebreyohannes@research.uwa.edu.au