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Master Thesis

Maintien ou arrêt d'une anticoagulation dans la fibrillation atriale : une décision difficile en médecine générale

Abstract : Background: Atrial fibrillation (AF) is a common arrhythmia and its prevalence increases with age. 30% of patients with an ischemic stroke have AF diagnosed. Oral anticoagulation can prevent the majority of stroke and systemic embolism but increases the bleeding risk. The objective of the trial is to analyse general practitioners practices in the management of anticoagulation for AF and to understand their difficulties, in order to propose a decision support tool to help them to take the best decision: keeping or stopping oral anticoagulation. Methods: This is a quantitative and descriptive trial realized with a questionnaire only sent to general practictioners. Results: 110 general practitioners were included in the trial. The issue of anticoagulation in AF was difficult for all physicians involved in the trial and among them 30 % have already stopped an oral anticoagulation. Antiplatelet remains an alternative of oral anticoagulation for patients with AF with bleeding risk for 18% of physicians and the risk of falls is still an important barrier to keep oral anticoagulation, especially among the elderly. A decision support tool has been derived from the results to help the physicians to take the right decision about anticoagulation for AF trying to not take the regular obstacles as a criteria. Conclusion: Around 30 % of patients with AF do not receive an oral anticoagulation and they are at risk of stroke, particularly the elderly and people with risk of falls. The aim of our decision support tool is to help physicians to take the right decision regarding the anticoagulation ; only patients with genuine contraindications should be not receive the treatment and should be oriented to left atrial appendage occlusion.
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https://dumas.ccsd.cnrs.fr/dumas-02924055
Contributor : Faculté de Médecine Amu <>
Submitted on : Thursday, August 27, 2020 - 4:33:58 PM
Last modification on : Saturday, August 29, 2020 - 3:22:46 AM

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  • HAL Id : dumas-02924055, version 1

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Sara Vibert. Maintien ou arrêt d'une anticoagulation dans la fibrillation atriale : une décision difficile en médecine générale. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02924055⟩

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