Hugo Diaz1, Haleh Bagheri2,3, Aurore Palmaro4,5,6,7, Vanessa Rousseau4,5,6, Robert Bourrel8, Jean-Louis Montastruc4, Jordan Birebent1. 1. Academic Department of Family Medicine, Faculty of Medicine Toulouse, University of Toulouse, Toulouse, France. 2. Medical and Clinical Pharmacology Unit, CHU Toulouse University Hospital, Toulouse, France. haleh.bagheri@univ-tlse3.fr. 3. Medical and Clinical Pharmacology Unit, CHU Toulouse University Hospital, Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, 37, Allées Jules Guesde, 31000, Toulouse, France. haleh.bagheri@univ-tlse3.fr. 4. Medical and Clinical Pharmacology Unit, CHU Toulouse University Hospital, Toulouse, France. 5. Medical and Clinical Pharmacology Unit, CHU Toulouse University Hospital, Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, 37, Allées Jules Guesde, 31000, Toulouse, France. 6. Pharmacoepidemiology Research Unit, INSERM 1027, University of Toulouse, Toulouse, France. 7. CIC 1436, Toulouse University Hospital, Toulouse, France. 8. Direction du Service médical de l'Assurance maladie (CNAMTS), Toulouse, France.
Abstract
AIM: The aim of our study was to study the pattern of prescription of direct-acting oral anticoagulants (DOACs) according to the French recommendations. METHODS: We performed a cross-sectional study using anonymous data of patients covered by the French National Health Insurance information system (SNIIRAM) from 1 January 2010 to 31 December 2013 in the area of Midi-Pyrénées (southwest of France). RESULTS: Of the 355,608 patients identified, 325,216 (91.5%) were included, of whom 22,142 received at least one DOAC. About 39.1% (8,652 patients) had DOAC in an orthopedic indication, 46.5% (10,303 patients) in a cardiac indication, and 16.1% (3568 patients) in an indeterminate indication. Overall, guidelines were largely followed as for renal function monitoring, prescribing in orthopedic indications, in cardiac indications in patients aged 80 years and older, and in the case of concomitant use of verapamil. However, inappropriate prescriptions were observed for cardiac indications, and for dosage adjustments in orthopedic indications, with respect to both the age of patients (75 years and older) and those taking verapamil or amiodarone concomitantly. Guidelines were more followed in women and patients aged 80 or more. CONCLUSIONS: Among patients receiving DOACs, 58% were exposed to a prescription falling outside the guidelines. This study on DOAC prescription patterns revealed insufficiencies in the compliance with the French guidelines in certain indications.
AIM: The aim of our study was to study the pattern of prescription of direct-acting oral anticoagulants (DOACs) according to the French recommendations. METHODS: We performed a cross-sectional study using anonymous data of patients covered by the French National Health Insurance information system (SNIIRAM) from 1 January 2010 to 31 December 2013 in the area of Midi-Pyrénées (southwest of France). RESULTS: Of the 355,608 patients identified, 325,216 (91.5%) were included, of whom 22,142 received at least one DOAC. About 39.1% (8,652 patients) had DOAC in an orthopedic indication, 46.5% (10,303 patients) in a cardiac indication, and 16.1% (3568 patients) in an indeterminate indication. Overall, guidelines were largely followed as for renal function monitoring, prescribing in orthopedic indications, in cardiac indications in patients aged 80 years and older, and in the case of concomitant use of verapamil. However, inappropriate prescriptions were observed for cardiac indications, and for dosage adjustments in orthopedic indications, with respect to both the age of patients (75 years and older) and those taking verapamil or amiodarone concomitantly. Guidelines were more followed in women and patients aged 80 or more. CONCLUSIONS: Among patients receiving DOACs, 58% were exposed to a prescription falling outside the guidelines. This study on DOAC prescription patterns revealed insufficiencies in the compliance with the French guidelines in certain indications.
Entities:
Keywords:
Direct oral anticoagulants; French guidelines; Pattern of prescription
Authors: Nihar R Desai; Alexis A Krumme; Sebastian Schneeweiss; William H Shrank; Gregory Brill; Edmund J Pezalla; Claire M Spettell; Troyen A Brennan; Olga S Matlin; Jerry Avorn; Niteesh K Choudhry Journal: Am J Med Date: 2014-05-21 Impact factor: 4.965
Authors: A John Camm; Gregory Y H Lip; Raffaele De Caterina; Irene Savelieva; Dan Atar; Stefan H Hohnloser; Gerhard Hindricks; Paulus Kirchhof Journal: Eur Heart J Date: 2012-08-24 Impact factor: 29.983
Authors: Paulus Kirchhof; Stefano Benussi; Dipak Kotecha; Anders Ahlsson; Dan Atar; Barbara Casadei; Manuel Castella; Hans-Christoph Diener; Hein Heidbuchel; Jeroen Hendriks; Gerhard Hindricks; Antonis S Manolis; Jonas Oldgren; Bogdan Alexandru Popescu; Ulrich Schotten; Bart Van Putte; Panagiotis Vardas Journal: Eur Heart J Date: 2016-08-27 Impact factor: 29.983