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Master Thesis

Évaluation des pratiques des médecins généralistes sur la prescription des anticoagulants oraux directs (dabigatran pradaxa®, rivaroxaban xarelto® et apixaban eliquis®) chez les personnes âgées de plus de 75 ans sur le secteur sanitaire palois

Abstract : Looking for an ideal anticoagulant, the pharmaceutical laboratories have developed direct oral anticoagulants (DOA), dabigatran etexilate (Pradaxa), rivaroxaban (Xarelto) and apixaban (eliquis) in order to overcome the disadvantages of oral vitamin K antagonists (VKA). The elderly are particularly affected by anticoagulants. The increase in OD sells, the numerous alerts of the ANSM and the HAS, and the lack of randomized- controlled trials which compare DOA and warfarine, raise the issue of how general practitioners (GPs) prescribe these drugs to elderly and frails patients. From December 2014 to April 2015 we interviewed the GPs of the health sector in Pau. Through a survey, they have been questioned on the prescription of DOA, the medical supervision, and the perception of adverse effects for over 75 year-old people. 118 GPs have answered our survey. It shows that 17.8% of them have no patient under DOA. Only 6.7% of GPs are the first-time prescribers of these drugs, indeed most of them are cardiologists. Rivaroxaban is the molecule most often prescribed. Non-valvular atrial fibrillation is the main indication. When a DOA treatment is introduced, a blood test is most of time performed (99%). For 75% of cases, GPs carry out a biological monitoring. However 20% of them use the Cockcroft-Gault formula for the creatinine clearance monitoring. Half of interviewed GPs have been faced with adverse events on DOA including mainly minor bleeding (epistaxis, gingival bleeding), gastrointestinal bleeding and digestive symptoms. Most of questioned GPs prefer to prescribe VKA thanks to the benefits of hindsight, the availability of antidotes, the knowledge of the drugs that the patients have and the possibility to check the observance by the biological assessment. Usually patients don’t ask many questions about anticoagulants. In 2015, GPs carefully prescribe DOA to elderly patients. In most cases, they aren’t the first-time prescribers of these treatments and they don’t seem to conscientiously follow the recommendations by preferring to introduce VKA to the frailest elderly patient.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01239373
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Monday, December 7, 2015 - 4:59:21 PM
Last modification on : Wednesday, August 23, 2017 - 4:33:52 PM
Long-term archiving on: : Saturday, April 29, 2017 - 10:03:07 AM

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Marina Carrier. Évaluation des pratiques des médecins généralistes sur la prescription des anticoagulants oraux directs (dabigatran pradaxa®, rivaroxaban xarelto® et apixaban eliquis®) chez les personnes âgées de plus de 75 ans sur le secteur sanitaire palois. Médecine humaine et pathologie. 2015. ⟨dumas-01239373⟩

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