Oral anticoagulants: Interventional pharmaceutical study with reminder of good practices, and iatrogenic impact

Objectives: Study of the impact of geriatricians' training on the improvement of their prescribing practices, and comparison of iatrogenesis between the two classes of oral anticoagulants.

Material and methods: Before/after and here/there comparison between a trained prescribers group and a control group, before and after the pharmacist intervention, with comparison of the iatrogenesis of two oral anticoagulant classes. Patients in the acute and post-acute geriatric departments treated with a vitamin K antagonist or a direct oral anticoagulant were included. Criteria for Good practice were rated according to a scale of severity: calculation of a score and a percentage of compliance per patient, and then an average of the percentage of compliance (main criterion) within the populations to be compared. The proportion of iatrogenic elements between the two classes was compared. We used statistical tests (significance threshold of 5%).

Results: Vitamin K antagonist: a decreasing trend in the control group (P=0.086) and an increasing trend in the trained group (P=0.183) was observed in prescription compliance before/after training. Direct oral anticoagulants: the compliance before/after decreased in the control group (P=0.005) and increased in the trained group (P=0.024). After training, compliance is higher among the group of trained prescribers for both vitamin K antagonist (P=0.018) and direct oral anticoagulant (P=0.003). The proportion of iatrogenic events in the two oral anticoagulants classes was not significantly different.

Conclusions: Interest of good practice reminders in the quality of oral anticoagulants prescriptions with no difference in safety of use between the two classes.