Évaluation de la prescription des anticoagulants oraux directs dans un service de court séjour gériatrique et suivi à 1 an

Abstract : Although new oral anticoagulants (NOACs) represents a therapeutic gain, the risk of misuse related to the complexity of their prescription, remains little studied in the geriatric population, which is the main target of anticoagulants. Objective: assess the compliance of NOACs prescriptions in a geriatric population, with respect to recommendations, after one year that the patient exited the hospital. Method: retrospective observational study of historical cohort type with follow-up, including patients hospitalized in geriatric unit at the university hospital of Caen between 01/01/2016 and 31/12/2017 and benefiting NOACs prescription. Follow-up was done by mail to the doctors. Results: 102 patients were included, with a mean age of 86 years. The prescribed NOACs are apixaban (67%), rivaroxaban (31%) and dabigatran (9%). Their indications are the prevention of stroke in case of nonvalvular AF (86%). The prescriptions are non-compliant according to the situations of haemorrhagic risk in 35% of case: 21% are under-dosed, 12% over-dosed, 2% contraindicated. Drug interactions are present in 24% of cases. The average duration of the follow-up date was 10 months. Amoung the 92 patients followed, we deplored 32 deaths and 9 hemorrhagic accidents, 4 of which were severe. The prescriptions of 82% of patients were continued, with a non-compliance rate of 37% and no biological monitoring of 14%. Conclusion: any prescription of a NOACs must be individualized and requires increased vigilance regarding compliance with contraindications, interactions, dosages and their adaptation to renal function. These results shows the need to strengthen the training of prescribers.
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https://dumas.ccsd.cnrs.fr/dumas-02097533
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Submitted on : Friday, April 12, 2019 - 10:02:49 AM
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Pauline Favé. Évaluation de la prescription des anticoagulants oraux directs dans un service de court séjour gériatrique et suivi à 1 an. Médecine humaine et pathologie. 2018. ⟨dumas-02097533⟩

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