The Psychology of Fear and How It Affects Treatment Decisions

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The MD Magazine Peer Exchange “Novel Anticoagulation Options: Target-Specific Oral Agents and Their Antidotes” features leading physician specialists discussing key topics in anticoagulation therapy, including the clinical characteristics of current and emerging agents and criteria for use in specific patient populations.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Scott Kaatz, DO, MSc, Chief Quality Officer at Hurley Medical Center in Flint, Michigan, and clinical associate professor at Michigan State University
• Seth Bilazarian, MD, clinical and interventional cardiologist at Pentucket Medical and instructor of medicine at Harvard Medical School
• Gerald Naccarelli, MD, Bernard Trabin Chair in Cardiology, professor of medicine and chief of the Division of Cardiology at Penn State University School of Medicine, and associate clinical director at Penn State Heart and Vascular Institute in Hershey, Pennsylvania
• Christian T. Ruff, MD, associate physician in the cardiovascular medicine division at Brigham and Women’s Hospital, and assistant professor of medicine at Harvard Medical School in Boston

The data for the novel oral anticoagulants show that they are more effective and safer than warfarin, and so, since they are not being used more widely, fear must be driving therapeutic decisions, guessed Ruff. He said he is optimistic that some of this fear will be abated by the reversal agents, but that will require a great deal of education about the data to overcome the psychological mindsets in place.

Naccarelli said that he thinks stroke neurologists are probably the biggest proponents of the new agents, because they deal with the effects of stroke every day, and because there are two treatments for intracranial hemorrhage: “one is don’t have it to begin with and the other is keep your fingers crossed.”