Physicians often avoid anticoagulation in elderly patients due to fear of bleeding, fall risk, non-adherence and monitoring concerns.
The PRO endpoints pursued in the studies were consistent with the concerns voiced by the patients in the focus groups, e.g. fear of bleeding and extreme fatigue.
Despite their high risk of stroke and the clear indication for anticoagulation treatment according to established risk scores, in practice, this treatment is often withheld from geriatric AF patients because of comorbidities and comedications, concerns regarding low treatment adherence, or fear of bleeding events, in particular due to falls.
This means that the education and counseling to participants that went along with the distribution of misoprostol on the dangers of PPH, prompted many women to opt to deliver at the hands of skilled birth attendant or health facility in fear of complications of bleeding after childbirth.
In addition to the SF-36, a study questionnaire asked patients to rate their fear of bleeding on a 4-point likert scale.
The current standard of care (warfarin) requires frequent blood tests, dietary changes, and constant fear of bleeding or clotting if the international normalised ratio is not in the target range.
The fear of bleeding complications with all currently available agents that inhibit the hemostatic system is real.
Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications.
Many reasons for this under-use have been identified, including low perceived risk of VTE in medical patients, absence of optimal tools for risk assessment, heterogeneity of patients and their diseases, and fear of bleeding complications (Kakkar et al 2004).
