Inappropriate direct oral anticoagulant prescriptions in patients with non-valvular atrial fibrillation: cross-sectional analysis of the French CACAO cohort study in primary care

Autor: Emilie Ferrat, Emmanuelle Boutin, Sylvie Bastuji-Garin, Paul Frappé, Julie Fabre, Philippe Galletout, Vincent Renard, Julien Le Breton
Přispěvatelé: Université Paris-Est Créteil Val-de-Marne - Faculté de médecine (UPEC Médecine), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), IMRB - CEPIA/'Clinical Epidemiology And Ageing : Geriatrics, Primary Care and Public Health' [Créteil] (U955 Inserm - UPEC), Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), AP-HP, hôpital Henri-Mondor, Clinical Research Unit (URC Mondor), F-94010 Creteil, France, Université de Saint-Etienne, The CACAO study was funded by the French National Agency for Continuing Medical Education (Agence nationale du Développement Professionnel Continu)., Tapia, Claudia
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Adult
medicine.medical_specialty
[SDV.SP.MED] Life Sciences [q-bio]/Pharmaceutical sciences/Medication
Cross-sectional study
Administration
Oral
Inappropriate Prescribing
030204 cardiovascular system & hematology
direct oral anticoagulants
Dabigatran
Brain Ischemia
Cohort Studies
03 medical and health sciences
primary care
0302 clinical medicine
[SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication
Internal medicine
Atrial Fibrillation
Medicine
Humans
030212 general & internal medicine
Prospective Studies
Medical prescription
Prospective cohort study
Aged
prescription
Primary Health Care
business.industry
Research
public health
Anticoagulants
Inappropriate Prescriptions
Stroke
Cross-Sectional Studies
Prescriptions
[SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie
Cohort
[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie
Apixaban
Family Practice
business
medicine.drug
Cohort study
Zdroj: The British Journal of General Practice
British Journal of General Practice
British Journal of General Practice, Royal College of General Practitioners, 2021, 71 (703), pp.e134-e139. ⟨10.3399/bjgp20X714005⟩
ISSN: 1478-5242
0960-1643
DOI: 10.3399/bjgp20X714005⟩
Popis: BackgroundDirect oral anticoagulants (DOACs) account for an increasing proportion of prescriptions in patients with non-valvular atrial fibrillation (NVAF) in primary care. Inappropriate dosing of DOACs is a common problem, with under-dosing being a particular issue. However, conflicting results have been reported about the factors independently associated with inappropriate dosing.AimTo describe inappropriate prescriptions of DOACs among patients in the CACAO French nationwide general practice cohort, and to identify the factors independently associated with inappropriate DOAC doses.Design and settingCross-sectional baseline analysis of the CACAO French national multicentre prospective cohort of adult patients in primary care receiving an oral anticoagulant who were recruited between April and October 2014.MethodA total of 1111 patients from the CACAO cohort who received a DOAC for NVAF were included in this study. Inappropriate prescriptions of DOACs were described (inappropriate dosage, contraindications, non-indications, interactions, and non-compliance with the precautions for use). Multivariate logistic models were used to investigate factors associated with inappropriate DOAC dosing (under-dosing and over-dosing).ResultsOverall, 438 patients (39.4%) received at least one inappropriate DOAC prescription. The most common inappropriate prescription was inappropriate dosage (n = 374, 33.7%), particularly under-dosing (n = 348, 31.3%). Multivariate analysis revealed that factors independently associated with under-dosing were older age, prescription of apixaban or dabigatran, and a CHA2DS2-VASc score ≥2 vs. a score = 1. Factors with over-dosing were kidney failure, a HAS-BLED score ≥3, and older age.ConclusionThe appropriateness of DOAC prescribing for NVAF can be improved, especially in older patients, and in patients with kidney failure, a higher risk of ischaemic stroke, and/or a higher risk of bleeding. GPs have a key role in increasing the proportion of appropriate DOAC prescriptions via informational, educational, and/or management strategies.
Databáze: OpenAIRE
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