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PLoS One. 2019 Feb 14;14(2):e0211695. doi: 10.1371/journal.pone.0211695. eCollection 2019.

A prescription support-tool for chronic management of oral antithrombotic combinations in adults based on a systematic review of international guidelines.

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Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), Paris, France.
Sorbonne Université, INSERM, AP-HP, Hôpital Pitié-Salpêtrière, Département de Cardiologie, Paris, France.
Observatoire du Médicament des Dispositifs Médicaux et de l'Innovation Thérapeutique Ile de France (OMEDIT), Paris, France.



Oral antithrombotic (AT) drugs, which include antiplatelet and anticoagulant therapies, are widely implicated in serious preventable bleeding events. Avoiding inappropriate oral AT combinations is a major concern. Numerous practical guidelines have been released; a document to enhance prescriptions of oral AT combinations for adults would be of great help.


To synthesize guidelines on the prescription of oral AT combinations in adults and to create a prescription support-tool for clinicians about chronic management (≥ one month) of oral AT combinations.


A systematic review of guidelines published between January 2012 and April 2017, in English or in French, from Trip database, Guideline International Network and PubMed, dealing with the prescription of oral ATs in adults was conducted. In-hospital management of ATs, bridging therapy and switches of ATs were not considered. Some specific topics requiring specialized follow-up (cancer, auto-immune disease, haemophilia, HIV, paediatrics and pregnancy) were excluded. Last update was made in November 2018.


A total of 885 guidelines were identified and 70 met the eligibility criteria. A prescription support-tool summarizing medical conditions requiring chronic management of oral AT combinations in adults with drug types, dosage and duration, on a double-sided page, was provided and tested by an external committee of physicians. The lack of specific guidelines for old people (age 75 years and older) is questioned considering the specific vulnerability of this age group to serious bleedings.


Recommendations on prescriptions about chronic management of oral AT combinations in adults were mainly consensual but dispersed in numerous guidelines according to the medical indication. We provide a prescription support-tool for clinicians. Further studies are needed to assess the impact of this tool on appropriate prescribing and the prevention of serious adverse drug events.

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at and declare no support from any organization for the submitted work. JPC reports grants from MEDTRONIC, grants from BMS/PFIZER, outside the submitted work. JPC works with the European Society of Cardiology. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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