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A Survey of Saudi General Practitioners on the Use of Thromboprophylaxis Guidelines and Risk Assessment Tools in
Mohammed Ibrahim Alnami1, Ali Mansoor Alsalim1, Ruwaida Faisal Alhakeem1
1Pharmaceutical Care Services, King Saud Medical City, Ministry of Health, Riyadh 11196, Saudi Arabia.
Insights
Saudi Arabian general practitioners (GPs) frequently use clinical guidelines and risk assessment tools for atrial fibrillation thromboprophylaxis. Guidelines are helpful, especially for complex cases, with CHA2DS2-VASc and HAS-BLED being preferred tools.
Area of Science:
- Cardiology
- General Practice
- Evidence-Based Medicine
Background:
- Clinical practice guidelines recommend oral anticoagulants for stroke risk in atrial fibrillation patients.
- Adherence to these guidelines can be inconsistent.
- Understanding general practitioners' (GPs) self-reported use of guidelines and risk assessment tools is crucial for improving thromboprophylaxis practices.
Purpose of the Study:
- To assess how Saudi Arabian GPs utilize clinical practice guidelines and risk assessment tools for atrial fibrillation (AF) thromboprophylaxis.
- To explore GPs' perceptions of available resources and guideline helpfulness.
Main Methods:
- A cross-sectional survey was conducted using self-administered questionnaires.
- Two hundred general practitioners (GPs) in Saudi Arabia participated in the study.
- Data collected included reported use of guidelines, stroke risk assessment tools (CHA2DS2-VASc, CHADS2, etc.), and bleeding risk assessment tools (HAS-BLED, HEMORR2HAGES).
Main Results:
- Over half of GPs (60%) used formal stroke risk assessment tools alongside clinical judgment.
- CHA2DS2-VASc (52.7%) and HAS-BLED (49.8%) were the most preferred tools for stroke and bleeding risk assessment, respectively.
- Guidelines were frequently consulted (28.4%) for difficult anticoagulation decisions and were generally perceived as extremely helpful.
Conclusions:
- Saudi Arabian GPs demonstrate a considerable reliance on clinical guidelines and formal risk assessment tools for managing atrial fibrillation thromboprophylaxis.
- The perceived helpfulness and clarity of guidelines, alongside the availability of preferred risk stratification tools, support their integration into clinical practice.
- Further efforts to promote guideline adherence and education on risk assessment tools can optimize stroke prevention in AF patients.
Abstract:
Clinical practice guidelines advise patients with atrial fibrillation who are at risk for stroke to undergo thromboprophylaxis with oral anticoagulants. However, it is noted that guidelines are not always followed. We sought to learn how Saudi Arabian general practitioners (GPs) self-reported using risk assessment tools and atrial fibrillation clinical practice guidelines created by cardiology associations, as well as how GPs felt about the resources that were available. Through the use of a self-administered questionnaire, we carried out a cross-sectional survey. A total of two-hundred GPs participated in the study. The guidelines were frequently used when a clinical decision regarding anticoagulation therapy appeared difficult (n = 57, 28.4%). The most predominant strengths of participants' chosen clinical guidelines were clear recommendations (n = 56, 27.9%), easy-to-follow algorithms (n = 39, 16.9%), detailed recommendations supported by evidence (n = 34, 16.9%), and online availability (n = 27, 13.4%). Many respondents said they used a formal stroke risk assessment tool in addition to their clinical judgment as a GP for most decisions (60%). Most respondents preferred using the CHA2DS2-VASc (n = 106, 52.7%), CHA2DS2-VA (n = 45, 22.4%), CHADS2 (n = 35, 17.4%), and GARFIELD (n = 14, 7.0%). HAS-BLED (n = 100, 49.8%) and HEMORR2HAGES (n = 50, 24.9%) were the most frequently utilized formal tools for assessing the risk of bleeding among GPs. Over half of the participants referred to guidelines when deciding thromboprophylaxis in patients with atrial fibrillation. Additionally, many respondents used formal procedures for assessing the risks of bleeding and stroke in addition to their clinical judgement in their roles as GPs. The guideline was assessed as being extremely helpful overall by GPs who used it to make thromboprophylaxis decisions.
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