title: [Which place for direct oral anticoagulants in routine hospital medical practice?].
abstract: OBJECTIVE
  More than one million patients received an oral anticoagulant treatment in France. This medication is the first aetiology of iatrogenic events. Recently, direct oral anticoagulant (DOA) provided efficacy and safety in the treatment of atrial fibrillation and venous thromboembolic events. Given the growing increase in the prescription of these molecules, with many advantages but also disadvantages, it seemed interesting to assess in routine hospital medical practice, the proportion of patients for which the initiation of AOD could be safe.
  
  
  METHODS
  This prospective, observational study was conducted in the department of internal medicine from October 2012 and September 2013. All inpatients receiving oral anticoagulant treatment have been included. Demographic data, indication of anticoagulant treatment, contraindications and interactions have been reported. From these information, we have established the percentage of patients who could benefit from DOA safely and securely.
  
  
  RESULTS
  Two hundred and ninety inpatients were included with a mean age of 76.3±15.2 years old. Atrial fibrillation and thromboembolic venous disease were the most prevalent indications of anticoagulant treatments (67.2% and 22.4% of cases respectively). Among all patients, 260 had an indication of DOA (89.7%), authorized by the French National health agency. Eighty percent had both indication and no contraindication for DOA. However, only 53.1% of patients neither had drug-drug interaction. Main contraindications were severe renal failure (clearance<30mL/min) in 10.7% of cases, and recent history of gastric ulcer in 15.3% of cases. The most frequent interactions with DOA were antiplatelet agent (14.5%) and amiodarone (11.6%). Almost two thirds of inpatients (65.1%) had at least one drug-drug interaction with VKA.
  
  
  CONCLUSIONS
  These results, coming from "real life", provide that only 53.1% of inpatients under anticoagulants could receive DOA safely. Caution is warranted, and VKA still have a preponderant role among anticoagulant drugs.
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: M
authors: M
authors: Khetta
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: Y
authors: Y
authors: Benhamou
authors: Département de pharmacie, CHU de Rouen, 76031 Rouen cedex, France.
authors: C
authors: C
authors: Tharasse
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: M
authors: M
authors: Le Besnerais
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: S
authors: S
authors: Miranda
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: N
authors: N
authors: Cailleux-Talbot
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: N
authors: N
authors: Girszyn
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: S
authors: S
authors: Ngo
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: G
authors: G
authors: Sauvêtre
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France.
authors: H
authors: H
authors: Lévesque
authors: Département de médecine interne, CHU de Rouen-Bois-Guillaume, 147, avenue du Maréchal-Juin, 76031 Rouen cedex, France. Electronic address: guillaume.armengol@chu-rouen.fr.
authors: G
authors: G
authors: Armengol
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors
chemical_list: D000925:Anticoagulants; D014812:Vitamin K
keywords: Anticoagulants oraux direct; Direct oral anticoagulant; Hospitalisation; Real life; Vraie vie