The following is the summary of “Qualitative Analysis of Patient–Physician Discussions Regarding Anticoagulation for Atrial Fibrillation” published in the October 2022 issue of Internal medicine by Martinez, et al.


Choice between warfarin and direct oral anticoagulants (DOAC) must be made when deciding whether to commence anticoagulation in patients with atrial fibrillation (AF) . There is a lack of information regarding how doctors include patients in this choice.  The purpose of this article is to provide a summary of the topics typically covered in anticoagulation talks between doctors and patients with AF. This qualitative content study covered medical visits from 2014 to 2020 in which doctors and patients who were new to anticoagulation discussed starting treatment. Core Metrics and Results Content-based analysis themes.

Of the 37 interactions, nearly all (34 [92%]) resulted in a DOAC prescription. About 25  (68%) of the patients were White; 15 (41%) were female, 22 (59%) were male; and 24 (65%) were 65 years old or older. Around 21 doctors were involved, with the vast majority being either cardiologists (14, or 67%) or men (19, or 90%). The analysis uncovered 4 primary categories and associated subcategories of themes related to doctors’ conversations with patients who are new to anticoagulation: the potential advantages and disadvantages of anticoagulant treatment, where doctors frequently resort to overly emotive language and overlook important considerations such as the dangerous of stroke relative to the risk of bleeding. Tradeoffs between warfarin and DOACs—doctors generally explain pros and downsides, use persuasive language, and deliver mixed signals, informing patients that warfarin and DOACs were fundamentally similar while concurrently claiming warfarin is rat poison; medication costs—physicians often tried to address patients’ questions about out-of-pocket costs, but they were unable to provide concrete answers, and they often provided free samples or coupons; direct-to-consumer pharmaceutical advertising about DOACs—physicians used direct-to-consumer pharmaceutical advertising about DOACs to orient patients to the issue of anticoagulation and the advantages of DOACs over warfarin.

Additionally, patients brought up DOAC class action litigation they had seen on television with their doctors.  This qualitative study of doctor-patient conversations on anticoagulation using DOACs revealed that doctors used persuasive language to get patients to agree to the treatment but were unable to answer patients’ concerns about the financial burden of the treatment. Patients unable to afford DOACs may experience additional stress or choose not to fill their prescriptions, putting them at risk of a stroke because of the delay in treatment.

Source: jamanetwork.com/journals/jamainternalmedicine/article-abstract/2798191