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Potentially inappropriate prescriptions of antithrombotic therapies in older outpatients: a French multicenter cross-sectional study

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Key summary points

AbstractSection Aim

To assess the prevalence of inappropriate prescriptions of antithrombotic therapies (AT) in older outpatients, and to examine the associated factors.

AbstractSection Findings

22.6% patients featured ≥ 1 in AT-STOPP criteria, 12.4% ≥ 1 in AT-START criteria. The most frequent AT-STOPP criterion was AT prescription despite a concurrent significant bleeding risk. The most frequent AT-START criterion was lack of AT prescription for patients with chronic atrial fibrillation. Two factors were associated with ≥ 1 AT-STOPP criteria: polymedication and previous hospitalization for a serious adverse drug event. The only factor associated with ≥ 1 AT-START criteria was lack of information in the prescription regarding the duration of treatment.

AbstractSection Message

Suboptimal prescribing of AT is common in GP’s prescriptions for older autonomous outpatients. Special attention should be given to those with polymedication and a history of severe adverse drug event.

Abstract

Purpose

To assess the prevalence of inappropriate prescriptions of antithrombotic therapies (AT) in older outpatients and examine the associated factors.

Methods

A multicenter cross-sectional study was performed in 75 community pharmacies of 11 French districts. The study included 1178 patients aged ≥ 75 years filling a prescription from a general practitioner (GP) at a community pharmacy (mean [SD] age 83 [± 5.5] years, 59% female, median prescribed drugs 7 [range 5–10]).75 pharmacy students prospectively collected data from structured interviews with patients and from prescriptions into an electronic case report. Updated 2014 STOPP/START criteria regarding AT were applied to each prescription. Factors associated with ≥ 1 AT-STOPP criteria and ≥ 1 AT-START criteria were studied (multivariate analysis).

Results

22.6% patients featured ≥ 1 in AT-STOPP criteria and 12.4% ≥ 1 in AT-START criteria. The most frequent AT-STOPP and AT-START criteria were AT prescription despite a concurrent significant bleeding risk and lack of AT prescription for patients with chronic atrial fibrillation, respectively. Two factors were associated with ≥ 1 AT-STOPP criteria: polymedication (≥ 5 drugs; p < 0.001) and previous hospitalization for a serious adverse drug event (ADE; p = 0.007). The only factor associated with ≥ 1 AT-START criteria was lack of information in the prescription regarding the duration of treatment.

Conclusion

Suboptimal prescribing of AT is common in GP’s prescriptions for older autonomous outpatients. The currently process of prescribing AT to older autonomous patients must be improved. Special attention should be given to those with polymedication and those with a history of severe ADEs.

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Acknowledgements

We are indebted to the 6th-year pharmacy students from Paris-Sud University for their outstanding efforts in collecting data.

Author information

Authors and Affiliations

  1. Université Paris Descartes, Paris, France

    Ségolène Dubois-Puechlong

  2. AP-HP, Hôpital Saint Antoine, Pharmacie, 75012, Paris, France

    Frédéric Mille, Patrick Hindlet & Christine Fernandez

  3. INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique, IPLESP, UMR-S1136, Sorbonne Université, 75012, Paris, France

    Patrick Hindlet, Yann de Rycke, Florence Tubach, Christine Fernandez & Dominique Bonnet-Zamponi

  4. Faculté de Pharmacie, Univ. Paris-Sud, 92296, Chatenay-Malabry, France

    Patrick Hindlet & Christine Fernandez

  5. Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique Santé Publique et Information Médicale, APHP, Hôpital Pitié Salpêtrière, Paris, France

    Yann de Rycke, Florence Tubach & Dominique Bonnet-Zamponi

  6. OMEDIT Ile de France, Paris, France

    Dominique Bonnet-Zamponi

Authors
  1. Ségolène Dubois-Puechlong
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  2. Frédéric Mille
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  4. Yann de Rycke
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  5. Florence Tubach
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  6. Christine Fernandez
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  7. Dominique Bonnet-Zamponi
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Contributions

Dubois-Puechlong, Tubach and Bonnet-Zamponi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dubois-Puechlong, Fernandez, Hindlet, Tubach, Bonnet-Zamponi: study concept and design. Dubois-Puechlong, Mille: acquisition of data. Dubois-Puechlong, Mille, Hindlet, de Rycke, Fernandez, Tubach, Bonnet-Zamponi: analysis and interpretation of data. Dubois-Puechlong, Bonnet-Zamponi: drafting of the manuscript. All authors: critical revision of the manuscript for important intellectual content. Mille, De Rycke: statistical analysis. Hindlet, Fernandez, Tubach, Bonnet-Zamponi: study supervision. All authors have seen and approved the final version of the submission.

Corresponding author

Correspondence to Ségolène Dubois-Puechlong.

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Conflict of interest

The authors have no financial or any other kind of personal conflicts with this paper.

Ethical approval

The university ethics committee approved the study protocol (no. NI-2016-03-03) and all procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Dubois-Puechlong, S., Mille, F., Hindlet, P. et al. Potentially inappropriate prescriptions of antithrombotic therapies in older outpatients: a French multicenter cross-sectional study. Eur Geriatr Med 10, 473–481 (2019). https://doi.org/10.1007/s41999-019-00176-2

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  • DOI: https://doi.org/10.1007/s41999-019-00176-2

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