Knowledge of Direct Oral Anticoagulants (DOACS) and Limits of Their Prescription: Survey of Cardiologists, Intensivists, Neurologists and Pulmonologists in Senegal

Introduction: Direct oral anticoagulants (DOACs) constitute a first-line therapy in non-valvular atrial fibrillation and venous thromboembolic disease. The aim of this study was to evaluate the prescription of DOACs among cardiologists, neurologists, intensivists and pulmonologists. Patients and Methods: We conducted a cross-sectional, descriptive study from June 1, 2023 to July 1, 2023, a period of one month. All cardiologists, neurologists, intensivists and pulmonologists who agreed to participate in the study were included. The parameters studied were related to the characteristics of the population, to knowledge and also DOACs prescribing. Data were collected using a pre-established survey questionnaire in paper and electronic format via Google form. Results: We included 218 subjects. Cardiologists were more represented (70.48%). The majority of specialists (70.77%) had between 0 and 5 years of experience. Among the subjects included, 33% claimed to have never had formal training about DOACs. The need for additional training was strongly expressed (85%). We found that 95% prescribed DOACs. The monthly frequency prescription was most often 1 to 2 times (40%). More than 3 out of 10 specialists prescribed DOACs for atrial fibrillation, pulmonary embolism and other situations. The reasons for replacing an AVK with a DOAC were dominated by the problem of compliance with VKAs and the absence of INR control using DOACs (54.7%). The reasons for replacing a DOAC with a VKA were dominated by the high cost of DOAC treatment (77.5%). The limitations of prescribing DOACs were dominated by the high monthly cost (66%), patient preference (14%), and specialist distrust of DOACs (6%). Concerning the compared cost of DOACs versus VKA, 33% of the population considered the cost of DOACs treatment equivalent to that of the overall cost of VKA treatment. Most specialists (99%) stated that their patients were satisfied with DOAC treatment. Conclusion: Direct oral anticoagulants (DOACs) are underused in Senegal due to their high cost but also due to lack of awareness linked to insufficient continuing training.