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Sixty-seven percent of those eligible completed the survey(n=1006).More than 85%of physicians responds that they always or often prescribe aspirin or other platelet antiaggregants regardless of degree of carotid artery stenosis,symptom status,or presence of surgical contra-indications. However,the reported frequency of use of these medications varied independently according to physical specialty(P=.044).In contrast,in addition to physician specialty,the reported frequency of anticoagulant use varied independently with degree of carotid artery stenosis,symptom status,and presence of surgical contraindications(P<.0001 for each variable).Fifteen percent of physicians responded that they always or often use anticoagulants for asymptomatic patients with 50%to 70%carotid artery stenosis versus 43%who reported doing so for symptomatic patients with a similar degree of stenosis(P<.0001);28%often or always prescribe anti-coagulants for asymptomatic patients with more than 70%carotid artery stenosis versus 49%who do so if symptoms are present(P<.0001).The odds of noninternist primary care physicians responding that they always or often use anticoagulants were more than five times higher(odds ratio,5.32,95% confidence interval[CI],3.79 to 7.45)than surgical specialists.Compared with surgical specialists,the odds ratios for the use of anticoagulants were 3.65 for internists(95%CI,2.63 to 5.06)and 1.88(95%CI,1.40 to 2.53) for neurologists.These data show the following:(1)Aspirin or other platelet antiaggregants are used by most physicians regardless of degree of carotid artery stenosis,symptom status,or presence of surgical contraindications;(2)anticoagulants are prescribed selectively,with each of these variable influencing their use;and(3)the use of both classes of agents varies with physician specialty training. |
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anticoagulant,treatment
anticoagulant,treatment in CVD
aspirin
carotid artery
carotid artery disease
carotid artery stenosis
cerebrovascular accident,prevention of
endarterectomy,carotid
endarterectomy,carotid-indications for
neurologic practice
platelet inhibiting drugs
practice guidelines
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