@article {Ferratbjgp20X714005, author = {Emilie Ferrat and Julie Fabre and Philippe Galletout and Emmanuelle Boutin and Julien Le Breton and Vincent Renard and Paul Frapp{\'e} and Sylvie Bastuji-Garin}, title = {{\textquotedblleft}Inappropriate Prescriptions of Direct Oral Anticoagulants among Patients with Atrial Fibrillation in General Practice: a Cross-sectional Analysis of the French CACAO Cohort Study{\textquotedblright}}, elocation-id = {bjgp20X714005}, year = {2020}, doi = {10.3399/bjgp20X714005}, publisher = {Royal College of General Practitioners}, abstract = {Abstract Background: Direct oral anticoagulants (DOACs) account for an increasing proportion of prescriptions in patients with nonvalvular atrial fibrillation (NVAF) in primary care. Inappropriate dosing of DOACs (especially under-dosing) is the most common problem. However, conflicting results have been reported with regard to the factors independently associated with inappropriate dosing. Aim: The present study{\textquoteright}s objectives were to describe inappropriate prescriptions of DOACs in the Comparison of Accidents and Circumstances with Oral Anticoagulants{\textquotedblright} (CACAO) French nationwide general practice cohort, and to identify factors independently associated with inappropriate DOAC doses. Design and setting: We performed an ancillary cross-sectional baseline analysis of the CACAO French national multicentre prospective cohort of adult patients in primary care receiving an oral anticoagulant and recruited from April to October 2014. We selected the set of CACAO patients having taken a DOAC for NVAF on inclusion (n=1111). Method: We described inappropriate prescriptions of DOACs (inappropriate dosage, contraindications, non-indications, interactions, and precautions for use) and then used multivariate logistic models to investigate factors associated with inappropriate DOAC dosing (under-dosing and over-dosing). Results: Overall, 438 patients (39.4\%) received at least one inappropriate DOAC prescription {\textendash} mainly an inappropriate dosage (33.7\%), and especially under-dosing (31.3\%). In a multivariate analysis, the factors independently associated with under-dosing were older age (odds ratio [95\% confidence interval] =1.03[1.02-1.05]), prescription of apixaban (3.93[2.29-6.74]) or dabigatran (1.55[1.17-2.06]), and a CHA2DS2-VASc score >=2 (2.39[0.92-6.18]) vs. a score=1 (0.73[0.23-2.34]). Conclusion: The appropriateness of DOAC prescribing for NVAF can be improved, especially in older patients, those with kidney failure, a higher risk for ischemic stroke and/or a higher risk for bleeding.}, issn = {0960-1643}, URL = {https://bjgp.org/content/early/2020/11/29/bjgp20X714005}, eprint = {https://bjgp.org/content/early/2020/11/29/bjgp20X714005.full.pdf}, journal = {British Journal of General Practice} }