Structure of prescription of gastroprotective drugs in patients receiving direct oral anticoagulants: results of a multicenter cross-sectional pharmacoepidemiological study

Background. In recent years, the frequency of prescribing direct oral anticoagulants (DOACs) for the prevention of thromboembolic complications in patients at risk for these conditions has sharply increased. However, taking some DOACs is associated with an increased risk of gastrointestinal bleeding and may cause dyspeptic symptoms that affect the prognosis and quality of life. In this regard, experts recommend considering the concomitant appointment of gastroprotectors for patients of this category. However, real clinical practice data on the appointment of gastroprotectors and drugs to protect the gastrointestinal tract in patients taking DOACs are practically absent in Russia. Objective. Evaluation of the frequency and structure of prescribing gastroprotective drugs in patients receiving DOACs. Methods. A multicenter cross-sectional (single-stage) pharmacoepidemiological study was conducted. From June 2021 to March 2022, data from inpatient and outpatient medicalrecords of662patients taking DOACs and examined in 26 centers in 15 cities of Russia (13 outpatient centers and 13 hospitals) were analyzed. Results. All 662 patients included in the study were taking DOACs. Previously, 64.8% of patients received DOACs, in 34.7% of cases they were prescribed for the first time. DOAC monotherapy was received by 86.6% of patients. Dual antithrombotic therapy (DOAC + antiplatelet) was prescribed in 10.6% of cases, triple therapy (DOAC + two antiplatelet agents) - in 2.8% of cases. Gastroprotective therapy (GPT) was administered to 57.1% of patients included in the study. The most commonly prescribed gastroprotective agents in patients taking DOACs and GPT were proton pump inhibitors (PPIs) - 80.2% and rebamipide - 27.8%. Monotherapy with any one gastroprotector and combination therapy, including 2 or more gastroprotectors in various combinations, were received by 89.2% and 10.8% of patients, respectively, among those who were prescribed GPT. In the case of DOAC monotherapy, 53.8% of patients received GPT, of which 63.9% took PPIs as monotherapy, 22.7% took rebamipide as monotherapy, and only 13.4% of patients received combined GPT. In general, gastroprotectors in the DOAC + ASA group were presented in the form of PPIs (monotherapy or as part of combined HPT - 94.3%) or rebamipide (22.9%). In the case of dual therapy (DOAC + clopidogrel), GPT was prescribed in 69.6% of cases; all patients received PPIs and only in one case - a combination of PPI and bismuth preparation. In the case of triple antiplatelet therapy, including DOAC and 2 antiplatelet agents, GPT was prescribed in 89.5% of patients. Conclusion. In Russia, in real clinical practice, the frequency of prescribing gastroprotectors to patients taking DOACs is only 57.1%, and since this directly affects the improvement of the prognosis of the disease, it is necessary to take additional measures aimed at raising physicians’ awareness of the need for such patient management tactics.

antiplatelet therapy, oral anticoagulants, gastroprotective therapy, proton pump inhibitors, rebamipide