Analyse des pratiques des médecins spécialistes du secteur sanitaire palois sur la prescription des anticoagulants oraux directs, chez les plus de 75 ans porteurs d’une fibrillation auriculaire non valvulaire

Abstract : Introduction: direct oral anticoagulants (DOAC) showed non-inferiority compared to vitamin K antagonists (VKA) for the prevention of ischemic accidents in atrial fibrillation (AF); however, more than 30% of elderly people with AF do not receive oral anticoagulation. We wanted to analyze the methods of prescription of DOAC by medical specialists in subjects over 75 years old with non-valvular AF. Materials and methods: from October 2017 to April 2018, we interviewed all DOAC primary-care specialists in the health sector in Pau. Through a questionnaire, we collected their prescribing habits in order to highlight the factors influencing the choice of anticoagulation, the criteria for dose reduction. Results: the majority of responder specialists are cardiologists (29 out of 45). Less 25% of their elderly patients do not receive anticoagulants. 83% of practitioners prefer DOAC, including cardiologists and neurologists (p=0.02). 61% prefer apixaban, especially geriatricians (p=0.01). 91% choose an VKA for severe renal failure and 50% a DOAC with a risk of drug interactions or poor compliance. 82% say that oral anticoagulation is challenged by weekly falls. All specialists evaluate renal function before prescribing a DOAC, of which 48% according to Cockcroft. More than 80% reduce the dosage of DOAC in patients with moderate renal impairment, age > 80 years and weight < 60 kg; 53% reduce it if combined with a platelet antiaggregant and 36% if frequent falls. 84% of specialists do not take the general practitioner’s advice and 66% want geriatric expertise. Conclusion: the anticoagulation of the elderly remains a question of balance between benefits and risks, requiring a personalized response and reassessed regularly according to the risk factors.
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Master Thesis
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Submitted on : Monday, March 11, 2019 - 6:21:36 PM
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Chloé Auriault. Analyse des pratiques des médecins spécialistes du secteur sanitaire palois sur la prescription des anticoagulants oraux directs, chez les plus de 75 ans porteurs d’une fibrillation auriculaire non valvulaire. Médecine humaine et pathologie. 2018. ⟨dumas-02064340⟩

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