Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Lecture:Putting evidence into practice
Slide content:Decision Analysis for Anticoagulation in Atrial Fibrillation Diamond is a decision node Circles are chance nodes 5.7 Chart: Decision analysis for anticoagulation in atrial fibrillation. Adapted from Guyatt (2014). 13
Slide notes:13 Here is an example of a simple decision analysis that revolves around the decision to use anticoagulation in a patient with atrial [ ey -tree- uhl ] fibrillation [fib- ril - lay -shun] . Atrial fibrillation is where the upper chamber of the heart fibrillates [ fib - ri - lates ], and blood can accumulate because its not properly pumped out of the atrium. This can form clots, and if the individual then goes back into a normal rhythm, the clot can be pushed forward out of the heart and pieces of it can potentially go up into the cerebral circulation and cause a stroke. There are basically three options for a patient with atrial fibrillation in whom we want to prevent stroke. We can do nothing, give no prophylaxis. We can use aspirin, which is a mild blood thinner. Or we can administer warfarin [ wawr -fuh-rin ], also known as Coumadin [ koo - muh -din], which is a much more potent blood thinner. For each of these options we have two possibilities: the patient can either have a stroke or not have a stroke. And any one of these options will potentially lead to adverse bleeding. Because we have two possible options, we have four permutations: no stroke with no bleed, a stroke with no bleed, no stroke with bleeding, and a stroke with bleeding. Obviously, the best thing for the patient would be to have neither a stroke nor bleeding. We know from the medical literature than warfarin is more effective at preventing stroke, but it also has a higher rate of bleeding. Wed actually apply numbers into these different pathways through the decision analysis to make our decision. The circles are the chance nodes because with each of these treatments theres a chance of any of those four outcomes; the diamond is the decision node for the decision that were trying to make.