Evaluation de la prescription des anticoagulants oraux directs

Abstract

Since their introduction to the market, direct oral anticoagulants (DOACs) have consistently attracted attention from the scientific community. This class of medications has proven to be at least as effective as conventional treatments (vitamin K antagonists and low molecular weight heparins), while offering several advantages over vitamin K antagonists. The aim of this study was to evaluate the prevalence and explore predictors of inappropriate dosage prescription of DOACs, in order to identify patients who may benefit most from dosage adjustment or a switch to a different DOAC type at an early stage. Our retrospective observational descriptive study spanned a period of 2 years and involved patients on DOACs (primarily rivaroxaban (62,2%) and apixaban (30,8%)). Routine hemostatic tests (PT, aPTT), complete blood count, renal and hepatic function tests were conducted, along with indirect measurement of factor Xa inhibitor drugs using anti-Xa activity via chromogenic assay. The study included a representative sample of 168 patients with a mean age of 70.25 ± 15 years. The majority of the population were female (68,2%). The mean BMI was similar for rivaroxaban and apixaban treatments (31,10 kg/m² and 32,80 kg/m², respectively), indicating elderly and predominantly obesity population. The mean glomerular filtration rate (GFR) for patients on rivaroxaban was 75.56 ml/min/1.73 m², while for those on apixaban it was 63,27 ml/min/1.73 m². Results revealed a significant prevalence of inappropriate prescriptions at 23,7%, affecting 47 patients. Key risk factors for inappropriate dosing identified in the study included advanced age, specifically those over 75 years (OR:0,439, CI:2,221- 0,018, p< 0.05), and a GFR below 50 ml/min (OR:3,789, CI:1,833-7,833, p=0,00). This highlights the challenges of dose adjustment to prevent complications. In conclusion, this study underscores the urgent need to strengthen prescription- monitoring strategies and enhance continuous education for prescribers. Adoption of standardized clinical protocols and decision support tools can help minimize risks and improve the safety and efficacy of treatments, particularly for elderly patients and those.