Assessment of Patients’ Awareness of Anticoagulant Use in Atrial Fibrillation: A Cross-Sectional Survey

Objective: Atrial fibrillation (AF) increases thromboembolic risk, and oral anticoagulants (OACs) substantially reduce this risk; however, their safe and effective use requires adequate patient knowledge. We aimed to assess AF- and OAC-related awareness among Turkish patients and to identify predictors of knowledge.
Method: This single-center, cross-sectional survey was conducted between July 1, 2024 and January 1, 2025, and included consecutive adults with non-valvular AF receiving warfarin or direct OACs for at least three months. A structured questionnaire collected data on demographic characteristics, comorbidities, medication use, adherence, and knowledge across six domains: arrhythmia name, treatment indication, dosing schedule, side effects, drug and food interactions, and consequences of dose modification. A composite knowledge score (range, 0–6) was calculated. Multivariable linear regression was used to evaluate predictors of knowledge, including age, sex, and education level. Ethics approval was obtained, and all participants provided written informed consent.
Results: A total of 261 patients were included (median age, 67 years; 50.2% women). Hypertension and diabetes mellitus were present in 64.8% and 32.2% of patients, respectively. Direct oral anticoagulants (DOACs) accounted for 72.4% of prescriptions, whereas 27.6% of patients received warfarin. Although 36% of participants had AF for more than six years, only 16.5% could correctly name their arrhythmia. While 92% knew they were taking an anticoagulant, 24% misunderstood its indication. Knowledge of side effects was limited, with 68% reporting no awareness. Awareness of interactions was poor: 88% reported no knowledge of drug–drug interactions, and 71% were unaware of food interactions. Most patients knew their dosing schedule (92.3%) and reported that they would not double a missed dose (99.6%). Self-reported adherence was high (94% “always” and 4% “often”), and taking medication with meals was associated with better adherence (χ² = 17.0, P < 0.001). The mean knowledge score was 2.8 ± 1.3 (Cronbach’s α = 0.50). Higher educational attainment and female sex were associated with greater knowledge, whereas age was inversely associated with knowledge.
Conclusion: Despite high self-reported adherence, substantial knowledge gaps persist among patients receiving anticoagulation for AF, particularly regarding side effects and drug or food interactions. Targeted, health-literacy-sensitive educational strategies may improve medication safety and clinical outcomes in patients receiving anticoagulation for AF.

Keywords: Atrial fibrillation, oral anticoagulants, patient knowledge