title: Areas of improvement in anticoagulant safety. Data from the CACAO study, a cohort in general practice.
abstract: BACKGROUND
  Real-world studies on anticoagulants are mostly performed on health insurance databases, limited to reported events, and sometimes far from every-day issues in family practice. We assess the presence of data for safe monitoring of oral anticoagulants in general practice, and compare patients' knowledge of taking an anticoagulant between vitamin K antagonists (VKA) and direct anticoagulants (DOAC), and the general practitioner's perception of their adherence to anticoagulation.
  
  
  METHODS
  The CACAO study is a national cohort study, conducted by general practitioners on ambulatory patients under oral anticoagulant. In the first phase, investigators provided safety data available from medical records at inclusion. They also evaluated patients' knowledge about anticoagulation and graded their perception of patients' adherence.
  
  
  RESULTS
  Between April and December 2014, 463 general practitioners included 7154 patients. Renal and hepatic function tests were respectively unavailable in 109 (7.5%) and 359 (24.7%) DOAC patients. Among patients with atrial fibrillation, 345 patients (6.9%) had a questionable indication of anticoagulant (CHA2DS2-Vasc<2). One hundred and thirty-three VKA patients (2.3%) and 70 DOAC patients (4.9%) answered they took no anticoagulant (p<0.0001). According to general practitioners' perception, 430 patients (6.1%) were classified as "not very" or "not adherent", with no difference between groups.
  
  
  CONCLUSIONS
  Our results highlight the efforts needed to improve anticoagulant safety in daily practice: decreasing the rate of unknown biological data in patients with DOACs or the rate of patients with VKA with no strong indication of anticoagulation, and improving patient knowledge with regard to their anticoagulant. Patients' adherence seems highly over-estimated by the general practitioners.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02376777.
authors.affiliation: Department of General Practice, University of Saint-Etienne, Saint-Etienne, France.|Inserm U 1059, Sainbiose DVH, University of Saint-Etienne, Saint-Etienne, France.|CIC-EC 1408, Saint-Etienne, France.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0002-7350-2824
authors.initials: P
authors.lastname: Frappé
authors.affiliation: Institut de Recherche en Médecine Générale, Paris, France.
authors.forename: Joël
authors.initials: J
authors.lastname: Cogneau
authors.affiliation: Department of General Practice, Grenoble Alpes University, Grenoble, France.|TIMC-IMAG UMR 5525, Grenoble Alpes University, Grenoble, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Gaboreau
authors.affiliation: Institut de Recherche en Médecine Générale, Paris, France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Abenhaïm
authors.affiliation: Department of General Practice, University of Lille, Lille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bayen
authors.affiliation: Department of General Practice, University of Lille, Lille, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Calafiore
authors.affiliation: Institut de Recherche en Médecine Générale, Paris, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Guichard
authors.affiliation: Department of General Practice, Grenoble Alpes University, Grenoble, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Jacquet
authors.affiliation: Institut de Recherche en Médecine Générale, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Lacoin
authors.affiliation: Inserm U 1059, Sainbiose DVH, University of Saint-Etienne, Saint-Etienne, France.|CIC-EC 1408, Saint-Etienne, France.|Department of Vascular Medicine and Therapeutics, CHU de Saint-Etienne, Saint-Etienne, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bertoletti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male
chemical_list: D000925:Anticoagulants