Background Our pharmacy department performs 150 Vitamin K antagonist (VKA) patient consultations annually. New oral anticoagulants (NOACs) are expected to replace VKAs in most of their indications. The variety of drugs and the different therapeutic schemes depending on the indications can be extremely hazardous. The NOAC marketing authorization (MA) came along with a European risk management plan.
Purpose To assess the prescription particularities of NOACs, further to the extension of their indication in cardiology in the management of atrial fibrillation (European Society Of Cardiology Guidelines in 2012).
Materials and Methods A retrospective study of NOAC prescriptions was performed from January 2011 till July 2012 to identify the main departments prescribing them and to evaluate the indications. Secondly, we questioned 2 cardiologists to determine the needs of patients and other healthcare practitioners for information about these treatments.
Results An increase in NOAC prescriptions was observed: 25 in 2011 and 41 in 2012 (7 months). The main prescribing departments were cardiology and orthopaedic surgery with respectively 48 and 12 patients. 18 prescriptions (2011) vs. 8 in 2012 did not match the recommendations. This was mainly due to prescription anticipating the MA in cardiology. Information needs identified by the cardiologists concerned prescription (switching from VKA-NOAC, effects of medicines altering the haemostasis and changing the dose required, perioperative management for optimal safety if the patient needs surgery or invasive procedures). The patient also needs to be informed (knowledge of the treatment, awareness of the risk of haemorrhage, self-medication and clinical surveillance of any bleeding).
Conclusions This preliminary research shows that it is necessary to supervise NOAC prescriptions and inform patients, to ensure these new treatments will be used properly. It allowed us to design a standard protocol for prescribing and monitoring NOAC. Our anticoagulant consultation programme will include these needs and NOAC patient consultation will be offered from January 2013.
No conflict of interest.
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