The management of patients treated with direct-acting oral anticoagulants for primary health care. Implementation of a clinical practice protocol: ZAR-ACOD project.

Abstract

Abstract Background: Oral anticoagulant treatment represents one of the most important therapeutic advances of the last century as an indication of chronic anticoagulation par excellence for atrial fibrillation. Direct oral anticoagulants (DOACs) stand out for their predictable effect at a fixed dose, reduction of drug interactions, and ease of use, since they do not require monitoring, which allows greater flexibility in management than vitamin K antagonists. Aim: Analyze the implementation of the management Protocol for direct-acting oral anticoagulants in primary health care. Methods: A quasi-experimental study was designed to improve the management of DOACs in patients with atrial fibrillation. The study began in June 2017 and ended in December 2018. The DOAC management protocol was developed by the research team following the recommendations of scientific societies. Results: Regarding the information received by the DOAC user, 15.4% did not know that they were taking an anticoagulant, 43.1% did not receive information about the DOAC at the time of prescription, and 21.5% received information written. Regarding the content of the information in primary health care, the information on the risk of bleeding was found in the upper part with 100%, followed by the importance of adherence with 90%. The follow-up need was met in 60%. 34.1% of patients with DOAC have a specific episode, 90.1% do not have any specific nursing follow-up visit, and the frequency of analytical controls is inadequate in 60.7% in patients older than 75 years. 62% with associated comorbidity and 75% with altered renal function. Conclusions: As a conclusion of the ZAR-ACOD study, the management Protocol for direct-acting oral anticoagulants has been correctly implemented in our population with atrial fibrillation. We can highlight the improvement in the follow-up and control of patients undergoing anticoagulant treatment after the application of the protocol.