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Master Thesis

Anticoagulants oraux directs (AOD) : enquête sur la perception et l’usage des AOD auprès d’un échantillon de médecins généralistes français en 2014

Abstract : Orally active small molecules that selectively and specifically inhibit coagulation have been developed for clinical use since 2008. For some patients these oral direct inhibitors (ODIs) offer substantial benefits over oral vitamin K antagonists (VKA). Dabigatran etexilate (Pradaxa ®), a prodrug of the direct thrombin inhibitor dabigatran and 2 direct inhibitors of factor Xa, rivaroxaban and apixaban are now routinely used. However, although routine coagulation monitoring is not required, the lack of consensus on their monitoring in bleeding and/or thrombotic circumstances, the poor understanding of which assays are appropriate for each ODI, the absence of specific antidotes and the numerous alerts issued by agencies (ANSM and HAS) raise the question of their daily uses by General Practitioners (GP). Our study, through a web questionnaire analyses knowledge, uses, management of bleeding events of French GPs in patients receiving ODI. Of 560 physicians randomly selected from five French regions 185 participated in our study. Results highlighted a good knowledge of ODI by the GPs: the lack of biological monitoring and antidote, the higher risk of bleeding in renal insufficiency and in geriatric populations are well understood. 54% of physicians are pessimistic about the replacement of VKA by ODI in the future, which highlights some suspicion with respect to these new therapies currently available in different indications for anticoagulation. The lack of antidote, the risk of bleeding, tolerance of patients with ODI and the cost of these new treatments, are the main obstacles cited by the physicians. Despite a negative perception of ODI, our study showed 84% of prescribers and 55% of primary prescribers. This is higher than what we expected as answer with regard to the different alerts issued from ANSM and HAS and the controversy about their use in the medical field. Factors encouraging the prescription of ODI are medical representatives (p=0.001), medical formation (p=0.014), male gender (p=0.02) and length of installation (p=0.001). About hemorrhages, 29.7% of GPs have observed bleeding events predominantly for rivaroxaban compared dabigatran explained by a largest prescription of rivaroxaban most in 2013. Only 16.3% of physicians have declared this side effect to the Pharmacovigilance which remains an important lever of drug safety.
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Master Thesis
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Raphaël Legagneux. Anticoagulants oraux directs (AOD) : enquête sur la perception et l’usage des AOD auprès d’un échantillon de médecins généralistes français en 2014. Médecine humaine et pathologie. 2015. ⟨dumas-01151162⟩



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