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Objectives: Pharmaceutical care for patients receiving oral anticoagulants (OACs) should be performed by trained healthcare professionals to prevent adverse effects and improve patient adherence. Before meeting patients, all pharmacy students in our department (in a one-year hospital internship program) experienced a theoretical training for several years. It was decided to add a practical component based on simulation training. The study reports the simulation program conception and the assessment of the simulation-based training for pharmacy students involved in conducting interviews with patients receiving ACOs., Methods: Organization and content of the training course were defined by two hospital pharmacists and one pharmacy resident. Skills' assessment was measured in pharmacy students in 3 steps: (1) initial assessment by individual interview, (2) group training by simulation, (3) final assessment by individual interview. Student satisfaction was also assessed at the end of the training., Results: Four scenarios and one assessment form were developed and 16 pharmacy students experienced the training. An improvement in skills after the simulations courses was observed in all parts of the process: the pre-interview (mean +15%), the interview itself (+16%) and the post-interview (+18%). All students felt more comfortable and motivated to conduct interviews and recommended that this training be continued., Conclusions: The study underlines the impact of the simulation training on students' skills and their satisfaction with the overall training program. The simulation training is now fully added to the program. Further studies should explore the skills improvement in real life during the first patient interview., (Copyright © 2024 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Subclasses of vitamin K, their origins, their differential characteristics of absorption and metabolism, their relative effects on gammacarboxylation of various proteins implicated in hemostasis andcoagulation, in bone calcification are not well known even by experts in these fields. These misunderstandings explain errors in recommendations for public and for patients. This review will not expose again the fundamentals on vitamins K as presented in the paper by Marc Guillaumont published in 2000 in this same journal. This 2011 review will try to update our actual knowledge and most of all will insist on their practical implications especially on the management of oral anticoagulant treatments since until recently vitamin K antagonist was the only available type of such a treatment. Several examples illustrate the need for a better understanding of this subject. The fear that diet vitamin K could deregulate the equilibrium of oral vitamin K antagonist treatment leads to recommend a quite total suppression of vitamin K containing components in the diet of anticoagulated patients. This leads to an opposite effect: a high sensitivity to vitamin K and to disequilibrium of the anticoagulant treatment while a comprehensivemoderate and regular diet intake of vitamin K first facilitates the food choice of the patients but also helps to stabilise the treatment of chronically anticoagulated patients. Vitamin K plays a role in bone calcification and in osteoporosis prevention. Until recently the food supplementation with vitamin K in view of preventing osteoporosis in general population was strongly limited due to fear to affect the treatment equilibrium in anticoagulated patients. While an understanding that the effects of moderate supplementation in vitamin K has no or limited effect on anticoagulation and on the long run could at the opposite help to stabilize the daily level of anticoagulation in patients chronically treated with vitamin K.

Résumé Propos L’arrivée des anticoagulants oraux directs (AOD) présentant des différences importantes avec les antagonistes de la vitamine K (AVK) pourrait modifier les pratiques. Dans ce contexte, nous avons réalisé une évaluation de la pertinence des prescriptions d’anticoagulants oraux (ACO) à la sortie de l’hôpital. Méthodes Il s’agit d’une étude rétrospective à partir du dossier patient informatisé réalisée entre août 2012 et juillet 2013 dans un service de médecine interne d’un hôpital régional suisse. Tous les patients sous AOD ont été inclus et chacun a été apparié à un patient sous AVK. Le critère de jugement principal était une prescription optimale de l’ACO à la sortie, définie par une indication adéquate, une posologie adéquate, le respect des contre-indications majeures, une prescription minimisant le risque d’interactions avec l’ACO, et l’absence de saignement majeur ou d’événement thromboembolique pendant l’hospitalisation. Le score HAS-BLED a permis d’évaluer le risque hémorragique chez les patients traités pour une fibrillation atriale (FA). Résultats Parmi les 44 patients inclus, 38 ont quitté l’hôpital avec une prescription d’ACO conforme à l’ensemble des critères. Deux patients avaient une posologie non adéquate. Un risque d’interaction était présent chez 3 patients sous AVK et 1 sous AOD. Aucune contre-indication majeure à l’ACO n’a été recensée, mais une contre-indication relative a été discutée dans 3 cas. La majorité des patients recevant un AOD pour une FA avaient un risque de saignement faible. Conclusion Aucune différence significative n’a été retrouvée entre les 2 groupes. Nos résultats semblent montrer une utilisation prudente des AOD. Background The recently introduced oral direct anticoagulants (ODAs), presumably safer, and with comparable efficacy to the vitamin K antagonists (VKAs), may reshape the world of anticoagulation medicine. This study aimed to assess the prescription appropriateness of ODAs and VKAs at discharge from hospital. Methods We performed a one year retrospective study between August 2012 and July 2013 in the department of internal medicine of a regional hospital (HVs Sion) using Electronic Medical Records. All patients receiving an ODA were included and matched to a patient treated with a VKA. The appropriateness of prescription at discharge was defined by an adequate indication and dosing, the absence of contraindication, a minimal risk of drug–drug interactions and no major bleeding or venous thromboembolism during the hospitalization. The bleeding risk was evaluated with the HAS-BLED score when the indication was atrial fibrillation (AF). Results Out of the 44 patients included (22 with an ODA and 22 with a VKA), 38 received an appropriate prescription according to all criteria. Two patients had an inadequate dosing. A potential drug–drug interaction was detected in 3 patients receiving a VKA and in 1 patient receiving an ODA. No major contraindication was found, but a relative contraindication was discussed in 3 cases. The majority of patients receiving an ODA for an AF had a minor bleeding risk. Conclusion No significant difference was ascertained between the two groups regarding the appropriateness of prescription. Our results suggest that ODAs were cautiously used in our setting. [ABSTRACT FROM AUTHOR]

Résumé Contexte Les résultats des études coût/efficacité des innovations thérapeutiques sont devenus un critère de référence dans la plupart des pays développés. Lorsque de nouveaux traitements proposent des alternatives à des traitements de référence éprouvés mais très peu coûteux, les payeurs anticipent un impact budgétaire important et cherchent à connaître la valeur supplémentaire apportée par ceux-ci. Objectif L'objectif de cette étude a été de présenter les différents modèles élaborés autour des trois premiers anticoagulants oraux directs (AOD), le dabigatran, le rivaroxaban et l'apixaban, ainsi que leurs résultats dans l'indication de prévention des accidents vasculaires cérébraux (AVC) pour les patients souffrant de fibrillation atriale (FA). Le périmètre de l'étude a été limité aux pays européens et au Canada, tous pays disposant d'un système de couverture universelle des dépenses de soins. Méthode À partir d'une revue de la littérature, les caractéristiques générales des études et leurs principaux résultats ont été présentés et comparés. Résultats Dix-neuf études ont été sélectionnées, couvrant onze pays européens et le Canada, comparant chacune des molécules aux antivitamines K (AVK) et entre elles. Toutes les études ont calculé un ratio de coût par QALY. La majorité des résultats (34/46) se situe au-dessous de 20 000 € par Quality-Adjusted Life Year (QALY). L'apixaban et le dabigatran à la dose de 150 mg bid présentaient les ratios les plus favorables. Conclusion Les nouveaux traitements présentent des ratios coût/efficacité acceptables en Europe et au Canada, au regard des standards habituels. Au-delà des différences intrinsèques entre les différents systèmes de santé, la diversité des résultats témoigne cependant d'une nécessaire standardisation des études à des fins de comparabilité. Background The cost-effectiveness analysis of therapeutic innovations has become a reference for decision makers in developed countries. When new treatments are available as alternatives to existing well established and cheap treatments, payers anticipate a major budget impact and will assess the extra benefit for society for extra Euros spent. Aims This study aimed at presenting the different published results of cost-effectiveness analyses performed for the three first new oral anticoagulants, dabigatran, rivaroxaban and apixaban, for the prevention of strokes for patients with atrial fibrillation. The study covered European countries and Canada, which all propose universal coverage for healthcare expenditures. Methods A literature review was performed. The general characteristics and main results of selected studies were presented and compared. Results Nineteen studies were selected, covering 11 European countries and Canada. All studies have performed the estimation of a cost per QALY. The majority of the results (34/46) were under €20,000 per QALY. Apixaban and dabigatran 150mg bid presented with the most favourable results. Conclusion New oral anticoagulants appear to have an acceptable cost-effectiveness ratio for European countries and Canada considering usual standards. Nevertheless, beyond intrinsic differences between healthcare systems, the observed variability of results strongly suggest a need for a standardisation of models used across countries. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Évaluer les modalités de prescription des anticoagulants dans la fibrillation atriale (FA) chez la personne âgée, à la fois d’un point de vue quantitatif (taux d’anticoagulation) et qualitatif (type d’anticoagulant). Les déterminants de la prescription et de la non-prescription ont également été analysés. Méthode Enquête de pratique, prospective, basée sur un cas clinique d’une patiente de 87 ans en FA et d’un questionnaire, conduite chez 60 praticiens (20 cardiologues [C], 20 gériatres [G] et 20 médecins généralistes [MG]). Résultats À la lecture du cas clinique, 88,3 % des médecins interrogés auraient initié un traitement ; trois types de traitement auraient été choisis : AVK (68,3 %), AOD (20,0 %) et antiagrégant plaquettaires (11,7 %). Le(s) critère(s) pris en considération dans l’instauration d’un traitement anticoagulant variaient en fonction de la spécialité d’exercice. Les cardiologues considéraient davantage le critère de l’âge (C : 95,0 % ; G : 75,0 % ; MG : 60,0 % ; p < 0,05), le diabète (C : 90,0 % ; G : 60,0 % ; MG : 55,0 % ; p < 0,05), l’HTA (C : 85,0 % ; G : 55,0 % ; MG : 60,0 % ; p < 0,05) et le sexe (C : 80,0 % ; G : 35,0 % ; MG : 25,0 % ; p < 0,05). La qualité de la fonction rénale était par contre un critère plus secondaire (C : 15,0 % ; G : 5,0 % ; MG : 0,0 % ; p < 0,05). La présence d’une cardiopathie sous-jacente était plus fréquemment retenue par les médecins généralistes (C : 35,0 % ; G : 5,0 % ; MG : 45,0 % ; p < 0,05) ainsi que les facteurs de risques cardiovasculaires usuels (surcharge pondérale ; dyslipidémie ; p < 0,05). Un risque hémorragique était cependant observé par 76,7 % des médecins dans la situation clinique présentée (C : 70,0 % ; G : 75,0 % ; MG : 85,0 % ; p < 0,05). Conclusion Cette enquête confirme que la FA reste sous anticoagulée chez la personne âgée et que les freins à la prescription d’une anticoagulation orale sont souvent sans fondement rationnel. Objective To assess prescribing of anticoagulants in atrial fibrillation (AF) in the elderly, both a quantitative point of view (rate of anticoagulation) and qualitative (type of anticoagulation). Determinants of prescribing and non-prescribing were also analysed. Methods Prospective survey of practice, based on one clinical case and questionnaire conducted in 60 practitioners (20 cardiologists [C], 20 geriatricians [G] and 20 general practitioners [GP]). Results In reading the clinical case, 88.3% of physicians would have initiated a treatment; three types of treatments would have been chosen: AVK (68.3%), ODA (20.0%) and platelet antiaggregant (11.7%). Criteria taken into account to initiate anticoagulation varied according to the specialty. Cardiologists considered more the age criteria (C: 95.0%, G: 75.0%, MG: 60.0%; P < 0.05), diabetes (C: 90.0%, G: 60.0%, MG: 55.0%; P < 0.05), hypertension (C: 85.0%, G: 55.0%, MG: 60.0%; P < 0.05) and female gender (C: 80.0%, G: 35.0%, MG: 25.0%; P < 0.05). The quality of renal function was however a more secondary criteria (C: 15.0%, G: 5.0%, MG: 0.0%; P < 0.05). General practitioners considered most frequently the presence of underlying heart disease (C: 35.0%, G: 5.0%, MG: 45.0%; P < 0.05) as well as usual cardiovascular risk factors (overweight, dyslipidaemia; P < 0.05). Risk of bleeding, however, was observed by 76.7% of physicians in the clinical situation presented (C: 70.0%, G: 75.0%, MG: 85.0%; P < 0.05). Conclusion This survey confirms that the FA remains under anticoagulated in the elderly and the barriers to the prescription of oral anticoagulation are often without rational basis. [ABSTRACT FROM AUTHOR]

Résumé: L’objectif du traitement antithrombotique au cours de la fibrillation atriale est de prévenir les accidents emboliques, et en premier lieu au niveau des artères cérébrales. Le bénéfice des antivitamines K (AVK) a été largement démontré par des essais randomisés. Les AVK réduisent le risque d’accident vasculaire cérébral et d’embolies systémiques de plus de 60%. Le bénéfice absolu est plus important chez les patients à haut risque embolique, notamment chez ceux ayant eu un infarctus cérébral ou un accident ischémique transitoire. Les AVK augmentent le risque d’hémorragie extra-ou intracérébrale, mais le bénéfice clinique net est pratiquement toujours en faveur du traitement. Pourtant, les AVK restent très largement sous-ou mal utilisés en routine. On estime que seulement un patient sur deux reçoit des AVK, que parmi les patients traités une large proportion n’est pas dans la fenêtre thérapeutique, et que beaucoup de patients finissent par interrompre le traitement. L’efficacité de l’aspirine pour prévenir les accidents emboliques est faible ou marginale et ce traitement n’est pas dénué de risque de complications hémorragiques. Ce traitement reste pourtant largement prescrit. L’association aspirine-clopidogrel est plus efficace que l’aspirine, mais est associée á un excés de risque d’hémorragie. Cette association doit étre préférée á l’aspirine seule chez les patients ayant une contre-indication formelle aux anticoagulants. [Copyright &y& Elsevier]

Abstract: Direct oral anticoagulants (DOAs), inhibitors of factor IIa or Xa, are expected to replace vitamin K antagonists in most of their indications. It is likely that patients on long-term treatment with DOAs will be exposed to elective or emergency surgery or invasive procedures. Due to the present lack of experience in such conditions, we cannot make recommendations, but only propose perioperative management for optimal safety as regards the risk of bleeding and thrombosis. DOAs may increase surgical bleeding, they have no validated antagonists, they cannot be monitored by simple, standardised laboratory assays, and their pharmacokinetics vary significantly from patient to patient. Although DOAs differ in many respects, the proposals in the perioperative setting need not be specific to each. For procedures with low risk of haemorrhage, a therapeutic window of 48h (last administration 24h before surgery, restart 24h after) is proposed. For procedures with medium or high haemorrhagic risk, we suggest stopping DOAs 5 days before surgery to ensure complete elimination of the drug in all patients. The treatment should be resumed only when the risk of bleeding has been controlled. In patients with a high risk of thrombosis (e.g. those in atrial fibrillation with an antecedent of stroke), bridging with heparin (low molecular weight, or unfractionated if the former is contraindicated) is proposed. In emergency, the procedure should be postponed for as long as possible (minimum 1–2 half-lives) and non-specific anti-haemorrhagic agents, such as recombinant human activated factor VIIa, or prothrombin concentrates, should not be given for prophylactic reversal, due to their uncertain benefit-risk. [Copyright &y& Elsevier]

Summary: Introduction: Thromboembolic events represent the final common mechanism in the pathogenesis of the most lethal vascular diseases in the developed countries (including acute coronary syndromes, ischemic stroke, deep vein thrombosis, and pulmonary embolism). Anticoagulant drugs, such as vitamin K antagonists (VKAs), heparin, low-molecular-weight heparin (LMWH), and, more recently, fondaparinux, form the cornerstone of prevention and treatment of thromboembolic diseases, and they are among the most widely used drugs in the Western world. However, these agents have important limitations. VKAs have a narrow therapeutic range and unpredictable pharmacokinetics (PK) and pharmacodynamics (PD), which are heavily influenced by genetic factors, drug-drug interactions, and dietary intake of vitamin K. Frequent laboratory monitoring and careful dose adjustment of VKAs are needed to ensure effective anti-thrombotic protection at a reasonably low risk of bleeding. Heparin, LMWH, and fondaparinux require subcutaneous injection, which makes them unsuitable for long-term treatments. Therefore, there is a real need for new, orally active anticoagulants with predictable PK/PD profiles that can be used without laboratory monitoring. Materials and methods: In this “state of the art” review, the authors examine literature retrieved from a PubMed Medline search with the keyword apixaban and no limits regarding date or language of publication, type of article, or field. Results: Apixaban is an oral anticoagulant developed for the prevention and treatment of venous thromboembolism, for stroke prevention in atrial fibrillation, and for secondary prevention in ischemic heart disease. It is a potent, reversible, highly selective, direct inhibitor of free and prothrombinase-bound factor Xa. It is characterized by > 50% oral bioavailability, peak plasma concentrations 1-3h after administration, and a 12-h terminal half-life. It also has low potential for drug-drug interactions and is eliminated through mixed renal and metabolic pathways (both CYP-mediated and CYP-independent). Apixaban has exhibited promising efficacy and safety profiles in different clinical conditions. Discussion: Apixaban is a promising new oral anticoagulant. However, additional studies on effectiveness and safety are needed to determine whether it can compete with the coumarins in the prevention and treatment of thromboembolic diseases. [Copyright &y& Elsevier]

Abstract: The risk of osteoporosis induced by the long-term use of anticoagulants is lower with low molecular weight heparins (LMWH) than with unfractionated heparin. The mechanisms implied in this bone loss still remain misunderstood. Some studies on animal models have shown a decreased bone formation with both heparins, and also an increased bone resorption only with unfractionated heparin. The role of the OPG-RANKL system could be implicated, with a higher affinity of unfractionated heparin than LMWH for OPG. No deleterious bone effect was shown in in vitro studies with the fondaparinux. As for oral anticoagulant therapy, the bone effects are controversial; some studies have shown an increased risk of fractures, however without confirmation by other authors. [Copyright &y& Elsevier]

Abstract: Introduction: Oral anticoagulants (OA) are effective in the prevention of cerebrovascular events among patients with atrial fibrillation (AF). However, several studies showed OA to be widely underused in these patients. The purpose of this study was to assess the use of OA and associated factors with non-use of this treatment. Methods: We conducted a retrospective study of 233patients affected by non valvular AF hospitalized in our institution between 2005 and 2007. Patients were stratified in three groups for stroke''s risk (high, moderate and low) according to the international antithrombotic therapy recommendations. Results: The average age of our patients was 64±14 years, with 35% of subjects being older than 75years. Hypertension was the more frequently reported risk factor for stroke (61%), followed by diabetes mellitus (19%) and congestive heart failure (12%). Five percent of the patients reported a stroke or a systemic embolic event history. Of the 233patients studied, 48% were stratified to the high risk group, among them 75% were being treated with OA, 20% with Aspirin® and 5% were taking no medications. To explore possible reasons for not prescribing anticoagulation, we analysed 27patients at high risk who did not receive OA. We found a low benefit/risk ratio (37%), neuropsychological impairment in 5%, a past bleeding episode in 6% but almost 50% of those patients reported no risk factors for haemorrhage. Conclusion: In our retrospective study, among 25% high-risk patients with non valvular AF were not treated with OA and one half of the patients report none of the factors associated with perceived or actual risk factors for bleeding. These data confirmed OA underuse, despite guidelines that delineate higher-risk patient populations for whom anticoagulation is recommended. [Copyright &y& Elsevier]

Résumé: Objectifs: Les cures de dexaméthasone sont souvent utilisées pour traiter l''amylose AL et le myélome multiple, deux maladies qui obligent souvent à un traitement antivitamine K en raison de thromboses (parfois liées au thalidomide) ou d''une amylose cardiaque ou rénale. Nous avons observé une potentialisation nette des antivitamines K par la méthylprednisolone puis, chez trois malades, par la dexaméthasone. Nous avons donc réalisé une étude prospective des interactions entre dexaméthasone et antivitamines K. Méthodes: Nous avons étudié neuf malades, dont six de façon prospective, pendant dix cycles de dexaméthasone au total. Parmi eux, six avaient un myélome et trois une amylose AL; huit prenaient de la fluindione et un de la warfarine. Les cures de dexaméthasone (40 mg/j pendant quatre jours tous les 28 jours) ont été données seules (quatre malades) ou en association avec du melphalan (cinq malades). Chez un malade, deux cures consécutives ont été étudiées en raison d''une augmentation modérée du International normalized ratio (INR) pendant la première cure. L''INR a été mesurée de façon répétée pendant les cures. Les concentrations plasmatiques d''antivitamine K ont pu être obtenues pendant cinq cures. Résultats: L''INR moyen a augmenté de 2,75 (extrêmes, 1,80 et 3,6) initialement à 5,22 (3,09 et 7,07) après la cure. Le traitement antivitamine K a été interrompu pendant huit cycles et une prise orale de 1 mg de vitamine K a été administrée pendant deux cycles. Aucune complication hémorragique grave n''a été constatée. Les concentrations plasmatiques d''antivitamine K ont augmenté après l''administration de dexaméthasone. Chez des malades témoins traités par dexaméthasone sans antivitamines K, le temps de prothrombine ne s''est pas allongé pendant les cures. Conclusion: La dexaméthasone à posologie élevée peut potentialiser les antivitamines K, conduisant à une augmentation marquée de l''INR. Une surveillance étroite de l''INR est donc indispensable en cas d''administration concomitante de ces deux médicaments, de façon à permettre l''adaptation de la posologie d''antivitamine K. [Copyright &y& Elsevier]

Abstract: Introduction: Vitamine K epoxide reductase complex subunit I (VKORC1) is a key enzyme in the vitamine K cycle, cofactor required for the activation of vitamine K-dependent clotting factors. Exegesis: VKORC1 recycles vitamine K 2,3 epoxide back to active vitamine K hydroquinone, an important factor for the carboxylation step of clotting factors. VKORC1 is the target enzyme of inhibition by oral anticoagulants or anti-vitamine K (warfarin, acenocoumarol). Conclusion: We show here the clinical consequences of genetic variations of VKORC1 during VKA therapy. [Copyright &y& Elsevier]

Since their approval, the direct oral anticoagulants have been widely used in the management of venous thromboembolism, for stroke and systemic embolism prevention in non valvular atrial fibrillation, and in venous thromboembolism prophylaxis after surgical hip or knee replacement. Because they are easy to use, with oral fixed doses and no biological monitoring need, they are more and more prescribed. New indications are rising in cancer associated thrombosis in France beyond the 6 first months of treatment, and to prevent cardiovascular events after an acute coronary syndrome, or in stable coronary or peripheral arterial disease in Europe. The efficacity and safety of direct oral anticoagulants in frail patients or in unusual pathological contexts are not entirely known, but further data are coming and will probably bring new answers., (Copyright © 2020. Published by Elsevier Masson SAS.)

Background: The recently introduced oral direct anticoagulants (ODAs), presumably safer, and with comparable efficacy to the vitamin K antagonists (VKAs), may reshape the world of anticoagulation medicine. This study aimed to assess the prescription appropriateness of ODAs and VKAs at discharge from hospital., Methods: We performed a one year retrospective study between August 2012 and July 2013 in the department of internal medicine of a regional hospital (HVs Sion) using Electronic Medical Records. All patients receiving an ODA were included and matched to a patient treated with a VKA. The appropriateness of prescription at discharge was defined by an adequate indication and dosing, the absence of contraindication, a minimal risk of drug-drug interactions and no major bleeding or venous thromboembolism during the hospitalization. The bleeding risk was evaluated with the HAS-BLED score when the indication was atrial fibrillation (AF)., Results: Out of the 44patients included (22 with an ODA and 22 with a VKA), 38 received an appropriate prescription according to all criteria. Two patients had an inadequate dosing. A potential drug-drug interaction was detected in 3patients receiving a VKA and in 1patient receiving an ODA. No major contraindication was found, but a relative contraindication was discussed in 3cases. The majority of patients receiving an ODA for an AF had a minor bleeding risk., Conclusion: No significant difference was ascertained between the two groups regarding the appropriateness of prescription. Our results suggest that ODAs were cautiously used in our setting., (Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Objective: To assess prescribing of anticoagulants in atrial fibrillation (AF) in the elderly, both a quantitative point of view (rate of anticoagulation) and qualitative (type of anticoagulation). Determinants of prescribing and non-prescribing were also analysed., Methods: Prospective survey of practice, based on one clinical case and questionnaire conducted in 60 practitioners (20 cardiologists [C], 20 geriatricians [G] and 20 general practitioners [GP])., Results: In reading the clinical case, 88.3% of physicians would have initiated a treatment; three types of treatments would have been chosen: AVK (68.3%), ODA (20.0%) and platelet antiaggregant (11.7%). Criteria taken into account to initiate anticoagulation varied according to the specialty. Cardiologists considered more the age criteria (C: 95.0%, G: 75.0%, MG: 60.0%; P<0.05), diabetes (C: 90.0%, G: 60.0%, MG: 55.0%; P<0.05), hypertension (C: 85.0%, G: 55.0%, MG: 60.0%; P<0.05) and female gender (C: 80.0%, G: 35.0%, MG: 25.0%; P<0.05). The quality of renal function was however a more secondary criteria (C: 15.0%, G: 5.0%, MG: 0.0%; P<0.05). General practitioners considered most frequently the presence of underlying heart disease (C: 35.0%, G: 5.0%, MG: 45.0%; P<0.05) as well as usual cardiovascular risk factors (overweight, dyslipidaemia; P<0.05). Risk of bleeding, however, was observed by 76.7% of physicians in the clinical situation presented (C: 70.0%, G: 75.0%, MG: 85.0%; P<0.05)., Conclusion: This survey confirms that the FA remains under anticoagulated in the elderly and the barriers to the prescription of oral anticoagulation are often without rational basis., (Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Atrial fibrillation (AF) is the most common arrhythmia. Its prevalence increases with age and increases the risk of stroke and systemic embolism. Few data are currently available on the quality of life (QOL) of anticoagulated patients with the advent of direct oral anticoagulants (DOAC). Our study aims to describe levels of QOL in elderly patients with AF receiving oral anticoagulants and compare QOL of patients treated with vitamin K antagonists (VKA) and DOAC. This prospective study included patients of 65 years and over, receiving anticoagulants for AF (VKA or DOAC) from general practice (n=70) or cardiac practice (n=30). The patients completed a self-administered questionnaire that included demographic, geriatric data and a QOL standardized scale: the anti-clot treatment scale (ACTS) 17 items exploring two dimensions "Burdens" and "Benefits". Eighty-nine patients were enrolled: 61 were taking VKA and 28 taking DOAC. Our two groups were comparable for all demographic and clinical characteristics studied. Our patients' mean scores were 48.6±12.1 on Burdens and 9.7±3.8 on Benefits. Burdens and Benefits scores were significantly better for patients treated with DOAC compared to patients with VKA (p<0.0001 and p<0.01, respectively). Anticoagulation in the elderly should be encouraged given the high thrombotic risk of AF. No matter what kind of molecule is chosen if in accordance to good guidance. Patients treated with ACOD seem to have a better QOL, but these results should be confirmed through larger randomized studies.

Abstract: New oral anticoagulants, soon available in clinical practice, will deeply change the management of venous thromboembolism. The main advantage of these drugs is the route of administration. Moreover, among the new oral anticoagulants, rivaroxaban has a better efficacy than enoxaparin to prevent thromboembolic events after major orthopaedic surgery (THR and TKR). In phase III studies, safety profile seems adequate. A new era for prophylaxis of VTE is beginning with the new oral anticoagulants. However, improvement in the management of patients with renal failure, obese patients or elderly is needed considering that these patients have a high thrombotic and/or hemorrhagic risk. [Copyright &y& Elsevier]