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Anticoagulation des patients gériatriques admis à l'hôpital souffrant de fibrillation atriale depuis la mise sur le marché des nouveaux anticoagulants oraux (NACO) : étude transversale rétrospective

Vandenabeele, Caroline

(2015)

Details

Supervisors

Dalleur, Olivia

Degree label

Certificat universitaire en pharmacie clinique

Abstract

Previous studies showed that approximately half of the geriatric population in atrial fibrillation did not receive anticoagulation despite a clear indication for the prevention of cardio-embolism 1•2. This study aimed at describing and identifying characteristics of anticoagulation among geriatric patients since the introduction of the new oral anticoagulants (NOAC; i.e. apixaban, dabigatran, rivaroxaban) on the Belgian market. The main endpoint was the use of anticoagulation before hospital admission.This retrospective cross-sectional study included geriatric patients from August 2012 to April 2015 admitted in a 900-bed academic hospital in Brussels. Patients were aged 75 years, with atrial fibrillation and clear anticoagulation indication (CHAOS, 2: 2) upon hospital admission. Ali patients benefited from a comprehensive geriatric assessment. Their risks of stroke and bleeding were predicted using, respectively, CHAD and HEMORRHAGES scores. This sample was compared to an historical sample (identical inclusion criteria) collected before the marketing of NOAC (January 2008 to December 2010)1 Results. From 2012 to 2015, anticoagulation was observed upon admission in 71% of the 275 patients (median age [P2s-P1s] :85,00 [81-88] years ; 53% female ; median CHAOS, :3 [2-4] ; median HEMORRHAGES : 3 [2-4]) meeting the inclusion criteria, consisting of vitamin K antagonist (40%), NOAC (22%) or heparin (9%). This rate is significantly higher than the rate observed in the historical sample (203/358 patients (57%) ; p-value < 0.001) collected before the introduction of the NOAC. ln the 2012-2015 sample, independent predictors of anticoagulation underuse (29%) were age (odds ratio [OR] [95% confidence interval] : 1.07 [1.01 - 1.1], per year) and antiplatelet therapy use (7.52 [4.1- 13.9]). The glomerular filtration rate < 30 mL/min seems to be predictive of the choice of vitamin K antagonist and/or heparin. Other factors (items of CHAOS2 or HEMORR 2HAGES, geriatric, demographic or clinical features) were not found to be predictive of the choice of anticoagulant (vitamin K antagonist and/or heparin or NOAC). The proportion of patients taking vitamin K antagonist and/or heparin tended to be lower after NOAC were introduced onto the market (49% vs 57% ; p-value = 0.057). Discussion, the introduction of NOAC onto the market influenced the prescribing pattern of anticoagulation in our study: anticoagulation underuse decreased and NOAC represent nowadays a significant proportion of prescribed treatments. Individual risks of bleeding or stroke do not influence the choice of anticoagulation.The underuse of anticoagulation in frail elderly patients decreased since the marketing of new oral anticoagulants.