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Updated: Jul 12, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation:
P J Devereaux1, D R Anderson, M J Gardner
1Department of Medicine, Dalhousie University, Halifax, Nova Scotia, B3K 6A3, Canada. philipj@mcmaster.ca
Insights
Patients with atrial fibrillation prioritize stroke reduction over bleeding risk more than physicians do. Individual patient values are crucial for antithrombotic treatment decisions, impacting stroke prevention and bleeding risk management.
Area of Science:
- Cardiology
- Clinical Decision Making
- Patient-Centered Care
Background:
- Atrial fibrillation (AF) necessitates antithrombotic therapy to prevent stroke.
- Balancing stroke risk reduction against bleeding risk is critical in AF management.
- Understanding patient and physician perspectives on treatment thresholds is essential for shared decision-making.
Purpose of the Study:
- To compare patient and physician thresholds for acceptable stroke risk reduction and bleeding risk with antithrombotic treatments in atrial fibrillation.
- To inform clinical practice regarding individualized antithrombotic therapy decisions in AF.
Main Methods:
- Prospective observational study involving 63 physicians and 61 high-risk AF patients.
- Utilized a probability trade-off tool during face-to-face interviews.
- Determined minimum stroke risk reduction and maximum acceptable bleeding risk for aspirin and warfarin.
Main Results:
- Patients required fewer prevented strokes (warfarin) to justify treatment compared to physicians.
- Patients accepted significantly higher rates of excess bleeding for both warfarin and aspirin compared to physicians.
- No significant difference was found between patients and physicians for aspirin's stroke reduction threshold.
Conclusions:
- Patients with AF place higher value on avoiding stroke and lower value on avoiding bleeding than their physicians.
- Individual patient preferences must be considered in antithrombotic treatment decisions for atrial fibrillation.
- This highlights a potential discordance in risk-benefit perception influencing treatment choices.
Objective:
To determine and compare physicians' and patients' thresholds for how much reduction in risk of stroke is necessary and how much risk of excess bleeding is acceptable with antithrombotic treatment in people with atrial fibrillation.
Design:
Prospective observational study.
Setting:
Tertiary and peripheral referral centres in Nova Scotia, Canada.
Participants:
63 physicians who were treating patients with atrial fibrillation and 61 patients at high risk for atrial fibrillation.
Main Outcome Measures:
Participants underwent a face to face interview with a probability trade-off tool. Thresholds were determined for the minimum reduction in risk of stroke necessary and the maximum increase in risk of excess bleeding acceptable for treatment with aspirin and warfarin in people with atrial fibrillation.
Results:
The minimum number of strokes that needed to be prevented in 100 patients over two years for warfarin to be justified was significantly lower for patients than for physicians (1.8 (SD 1.9) v 2.5 (1.6), P=0.009), whereas for aspirin there was no difference between patients and physicians (1.3 (1.3) v 1.6 (1.5), P=0.29). The maximum number of excess bleeds acceptable in 100 patients over two years for use of warfarin and aspirin was significantly higher for patients than for physicians (warfarin 17.4 (7.1) v 10.3 (6.1); aspirin 14.7 (8.5) v 6.7 (6.2); P<0.001 for both comparisons).
Conclusions:
Patients at high risk for atrial fibrillation placed more value on the avoidance of stroke and less value on the avoidance of bleeding than did physicians who treat patients with atrial fibrillation. The views of the individual patient should be considered when decisions are being made about antithrombotic treatment for people with atrial fibrillation.
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