Abstract WP83: The Challenges Of Stroke Prevention Following Intracerebral Haemorrhage; A Qualitative Study Exploring Physicians’ Decision Making.

Introduction: Initiating long-term oral anticoagulation (OAC) therapy in intracerebral haemorrhage (ICH) survivors who have atrial fibrillation (AF) has clinical equipoise for stroke physicians internationally, given the lack of clinical trial evidence. Understanding how physicians make decisions about stroke prevention in these patients will support and improve current decision-making practice and inform future guidelines. Aim: To explore physicians’ decision-making around prescription of long-term OAC for stroke prevention in patients with AF following an ICH. Methods: Qualitative sub-study of the PREvention of STroke in Intracerebral haemorrhaGE survivors with Atrial Fibrillation (PRESTIGE-AF) trial [NCT NCT03996772]. Semi-structured interviews with data analysed using Framework analysis. Results: Twenty stroke physicians (women n = 6 (30%), consultant in stroke medicine n =10, head of stroke department n = 6, geriatrician working in stroke n = 2, residents in neurology n = 2) across five European countries (Spain, France, Germany, Austria, UK) participated. The overarching theme ‘Managing Uncertainty’ highlights the difficulties faced by physicians. It draws together three sub-themes: ‘Computing the risks’, focusing on how physicians weigh-up the risks and benefits of long-term OAC; ‘The patient perspective’, which considers patients’ experiences and preferences; ‘Making the decision together’, which focuses on issues of communication between physicians and patients. Conclusion: The need to balance risks/benefits in the absence of data from randomised controlled trials and the uncertainty surrounding long-term outcomes of OAC were key challenges for physicians. Physicians rely on past personal clinical experience and collegiate advice to aid decision making. Physicians strive to ensure that patients understand the decision-making process. Future practice should support physicians in communicating clinical uncertainty to patients and encourage patients and physicians to work together to understand individual patients’ needs. Funding: This project has received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 754517.