Implementation of a tool for the pharmaceutical analysis of prescriptions of direct oral anticoagulants and interest of its application in practice

摘要

The launch of new oral anticoagulants (NOACs) or direct oral anticoagulants (DOA) in 2008 emerged as a therapeutic gain in the drug therapy of patients in comparison with vitamin K antagonists. This new pharmaceutical class avoids a biological monitoring and should simplify dosages. However, the risk of misuse and iatrogenesis are high. Objective: The objective was to assess compliance with the medical requirements of the rules of use of NOACs. Materials and methods: This is a retrospective study based on the analysis of dabigatran and rivaroxaban prescriptions between January 2012 and May 2013 in the Hospital of Compiegne-Noyon. For the pharmaceutical analysis of DOAs's prescriptions an Excel ? file has been created. After filling the different items (indication, renal and hepatic function, age, drug combinations), this file is used to provide the recommended dosage. This dosage has been compared to the prescription in order to identify non-compliance with the recommendations and their root causes. Results: 112 prescriptions have been analyzed, 66% were compliant. Among the 34% non-compliant: 79% (30) were under-dosing; 8% (3) were overdoses: any dose adjustment for renal function; 8% (3) cons-indications: including 2 associations with low-molecular-weight heparin (LMWH); 5% (2) non-indications: patients treated for wrist fracture and proximal femoral nail. Conclusion: This study shows the lack control and distrust of prescribers with these new drugs without biological monitoring or antidote available as demonstrated by the large number of underdosing. It demonstrates the importance of the pharmaceutical analysis to identify and correct non-conformities, made easier by the developed Excel? tool.