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Bleeds discourage use of warfarin

Doctors prescribe warfarin less often after having a patient who has suffered an anticoagulation-related bleed, new research concludes. But a stroke in a patient not on warfarin did not increase the likelihood a doctor would prescribe it.

Researchers warned that as the prevalence of atrial fibrillation increased it was 'essential' to tackle barriers to underuse of warfarin.

The US/Canadian study of 530 doctors found their likelihood of prescribing warfarin in patients with atrial fibrillation fell 23 per cent after a patient suffered a serious bleed.

Study leader Dr Niteesh Choudhry, instructor in medicine at Harvard Medical School, said: 'Our findings provide further insight about reasons for underuse of warfarin in the treatment of atrial fibrillation.'

He added that efforts to increase prescribing of anticoagulation therapy should address 'doctors' perception of risk'.

Dr Jonathan Mant, senior lecturer in general practice at the University of Birmingham, said: 'If someone has a major bleed you're getting reinforcement that warfarin is bad, but you don't get reinforcement when patients haven't had a stroke.

'It's important to point out that if you have one patient with a bleed you will have had five or six patients who won't have had a stroke.'

The study, published early online in the BMJ, identified the doctors responsible for 3,120 patients with atrial fibrillation in the 90 days before and after they had suffered a serious bleed. It then identified 1,060 patients also treated for atrial fibrillation by the same doctors.

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