چکیده (انگلیسی):

Background:Oral anticoagulant therapy reduces the risk of stroke in patients with atrial fibrillation, but many
patients are still not prescribed this therapy. The causes of underuse of vitamin K antagonists oral anticoagulants
are not clear but could be related, in part, to patients’ and physicians’ perceptions and attitudes towards the
benefits and downsides of this treatment. The purpose of this systematic review was to evaluate and synthesize
patients’ and physicians’ perceptions and attitudes towards the benefits and downsides of vitamin K antagonist,
in order to explore potential factors related with its underuse.
Methods:We included studies that used qualitative or mixed methods and focused on patients’ and/or physicians’
perceptions and attitudes towards oral anticoagulation. We systematically searched PubMed, EMBASE, ISI WoK, and
PsycINFO from their inception until May 2013. Two reviewers independently assessed the quality of the included
studies and synthesized results using a thematic analysis approach.
Results:We included a total of nine studies. In four studies, the quality assessed was excellent and in five was moderate.
We identified three themes that were of interest to both physicians and patients: information to reinforce anticoagulation
use, balance of benefits and downsides, roles in decision-making and therapy management. Three additional themes
were of interest to patients: knowledge and understanding, impact on daily life, and satisfaction withtherapy. The main
difficulties with the use of anticoagulant treatment according to physicians were the perceived uncertainty, need of
individualised decision-making, and the feeling of delegated responsibility as their main concerns. The main factors for
patients were the lack of information and understanding.
Conclusion:Physicians’ and patients’ perceptions and attitudes might be potential factors in the underuse of treatment
with vitamin K antagonists. Improving the quality and usability of clinical guidelines, developing tools to help with the
decision-making, enhancing coordination between primary care and hospital care, and improving information provided
to patients could help improve the underuse of anticoagulation.