# Barriers Interfere With Wide Usage of NOAC for Prevention of Thromboembolic Events Among Doctors in Sudan: A Cross-Sectional Survey February 2023

## TL;DR

This study explores why doctors in Sudan are not widely using new anticoagulants (NOACs) for preventing blood clots, identifying factors like lack of guidelines, cost, and unavailability.

## Contribution

The study identifies specific barriers to NOAC usage among Sudanese doctors, including guideline awareness, cost, and multidisciplinary collaboration.

## Key findings

- Over 60% of doctors cited unavailability of NOACs as a major barrier to their prescription.
- 70.2% of participants reported that lack of a multidisciplinary team approach hinders NOAC use.
- Half of the participants were unaware of the 2021 DOACs guideline.

## Abstract

Background: Ischemic heart disease and stroke kill 25% of people worldwide. Vitamin K antagonist (warfarin) is the most widely used oral anticoagulant. Although affordable and effective, its usage is limited in many patients due to anticoagulation level variability and other factors, its alternatives include new nonvitamin K antagonist oral anticoagulants (NOACs). The study aims to investigate NOAC usage barriers.

Methods: This is an observational, cross-sectional study, involved 144 doctors from different specialties and different medical degrees in Khartoum state, the data were collected by an author designed close-ended questionnaire. Data were entered, cleared and analyzed using Statistical Package for Social Sciences (SPSS) V25.0 software.

Results: Medicine was most common (45.8%) among 144 medical department participants. The most prevalent medical degrees were registrars (25%) and doctors (25%). Specialists (22.9%), then house officers (15.3%). Over half (51.4%) had worked less than 5 years. 50% did not know about the 2021 DOACs guideline. 60.4% claimed DOACs' unavailability inhibits prescription. The lack of a multidisciplinary team approach hinders DOACs prescription, said 70.2%.

Conclusion: Sudanese clinicians' hurdles to using NOAC for thromboembolic episodes were explored. Lack of a reversal agent and multidisciplinary team approach hinder DOAC prescription. Lack of information about international guidelines, since most participant's preferred specialized advice or personal experience, and high DOAC costs and inaccessibility and unavailability are other important barriers. Medical practitioners should update guidelines and government insurance plans should include DOACs. Each department should start studies separately.