International Journal of Clinical Pharmacy

, Volume 39, Issue 2, pp 468–472 | Cite as

Patient preferences regarding atrial fibrillation stroke prophylaxis in patients at potential risk of atrial fibrillation

  • Nicholas T. Edwards
  • Erica D. Greanya
  • I fan Kuo
  • Peter S. Loewen
  • Celia L. CulleyEmail author
Short Research Report


Background With an increasing number of options for atrial fibrillation (AF) stroke prophylaxis, there are several medication-related factors to consider. This study aimed to gain a better understanding of which preference factors influence patient decisions when selecting AF stroke prophylaxis. Objective To determine the factors that influence patient stroke prophylaxis decisions and preferred therapeutic options. Methods A questionnaire about AF stroke prophylaxis medication options was distributed to participants at risk of AF. Preferences were elicited through ranking and rating medication preference factor statements, then selecting most and least preferred treatment options. Results Reduced stroke risk and lowest risk of an intracranial haemorrhage (ICH) had the highest median preference factor ranking of 2 (IQR, 1–3.5 for stroke reduction; 2–4 for ICH risk). Reducing stroke risk, availability of a lab test to assess drug effect, and availability of an antidote were the preference factors with the highest ratings. Apixaban was the most preferred treatment option (44% blinded to drug name, 37% unblinded) while ‘No treatment’ was the least preferred option (48% blinded, 52% unblinded). Conclusions Reducing stroke risk and limiting ICH risk were the most important medication factors to participants. High inter-participant preference variability suggests the importance of including the patient in decision-making when selecting AF stroke prophylaxis.


Anticoagulation Atrial fibrillation Canada Outpatients Patient preference Prevention Shared decision making Stroke 



The authors would like to thank Rebecca Barnes (Island Health Research and Capacity Building) for her assistance with questionnaire administration.


No financial support was provided for the conduction of this research.

Conflicts of interest

The authors have no conflicts of interest to disclose.

Supplementary material

11096_2017_440_MOESM1_ESM.docx (175 kb)
Supplementary material 1 (DOCX 174 kb)
11096_2017_440_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 14 kb)


  1. 1.
    Wolf PA, Dawber TR, Thomas HE Jr, Kannel WB. Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the framingham study. Neurology. 1978;28(10):973–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Baczek VL, Chen WT, Kluger J, Coleman CI. Predictors of warfarin use in atrial fibrillation in the Unites States: a systematic review and meta-analysis. BMC Fam Pract. 2012;13:5.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Huff CT, Guigliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trial. Lancet. 2014;383:955–62.CrossRefGoogle Scholar
  4. 4.
    Xu Y, Holbrook AM, Simpson CS, Dowlatshahi D, Johnson AP. Prescribing patterns of novel oral anticoagulants following regulatory approval for atrial fibrillation in Ontario, Canada: a population-based descriptive analysis. CMAJ Open. 2013;1:E115–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Mohammed I, Syed W, Kowey PR. Oral anticoagulants to reduce the risk of stroke in atrial fibrillation: how should a clinician choose? Clin Cardiol. 2013;36(11):663–70.CrossRefPubMedGoogle Scholar
  6. 6.
    MacLean S, Mulla S, Akl EA, Jankowski M, Vandvik PO, Ebrahim S, et al. Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e1S–23S.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Palacio AM, Kirolos I, Tamariz L. Patient values and preferences when choosing anticoagulants. Patient Prefer Adherence. 2015;9:133–8.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Holbrook A, Labiris R, Goldsmith CH, Ota K, Harb S, Sebalt RJ. Influence of decision aids on patient preferences for anticoagulant therapy: a randomized trial. CMAJ. 2007;176(11):1583–7.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Fuller R, Dudley N, Blacktop J. Avoidance hierarchies and preferences for anticoagulation—semi-qualitative analysis of older patients’ views about stroke prevention and the use of warfarin. Age Ageing. 2004;33(6):608–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing 2017

Authors and Affiliations

  • Nicholas T. Edwards
    • 1
  • Erica D. Greanya
    • 1
    • 2
  • I fan Kuo
    • 3
  • Peter S. Loewen
    • 2
  • Celia L. Culley
    • 1
    • 2
    Email author
  1. 1.Department of PharmacyIsland HealthVictoriaCanada
  2. 2.Faculty of Pharmaceutical SciencesThe University of British ColumbiaVancouverCanada
  3. 3.Faculty of PharmacyUniversity of ManitobaWinnipegCanada

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