Study of the Interest of Patients Undergoing Anti-thrombotic Treatment in a Digital Application of Therapeutic Assistance
Study of the Interest of Patients Undergoing Anti-thrombotic Treatment in a Digital Application of Therapeutic Assistance
Medical ethics encourages medical personal to actively care for patients, however old they
 may be, if they have maintained their physical autonomy and mental integrity to travel the
 path of medical care together. Many of the patients are in this situation today and their age
 does not seem to be a limiting factor in the care required.

 For more than 60 years, antithrombotics have played a major role in the management of
 thromboembolic and arterioatheromatous diseases. the doctors have therefore seen the advent
 of low molecular weight heparins, new platelet antiaggregants and then direct oral
 anticoagulants.

 If their contribution is no longer discussed today, it is necessary to take into
 consideration the risks they cause, particularly in terms of haemorrhage. Indeed,
 antithrombotics are the leading cause of serious adverse reactions in France with
 anti-vitamins K (AVK) which are the leading cause of hospitalization for severe iatrogeny in
 France. This risk is increased by the coexistence of haemorrhagic risk factors: drug
 interaction, misuse, failure to comply with contraindications and precautions for use,
 especially as exposure to these drugs increases with age.
The risk of bleeding varies in different populations and according to the treatment used.
 Severe bleeding under AVK has an incidence of 0.6 to 10% per year. Fatal hemorrhage is in the
 order of 1%. The risk factors for bleeding are controversial: history of bleeding in the
 patient, instability of the International Normalized Ratio (INR) at the time of introduction
 of KVAs and during the first few months, poor patient compliance, drug combinations
 (antiplatelet, non-steroidal anti-inflammatory drugs: NSAIDs, paracetamol, etc.) or
 association with alcohol. National pharmacovigilance data indicate that serious accidents are
 not uncommon due to frequent misuse of antithrombotics in common practice.

 There are risk factors related to the patient and his or her comorbidities: history of
 bleeding, stroke, comorbidities such as age > 65 years, diabetes, cancer, chronic renal
 failure.

 Despite the various aids to therapeutic patient education (surveillance logbook, computerised
 INR monitoring), there has been no decrease in the frequency of iatrogenic accidents, either
 in hospitals or in urban medicine.

 The use of smartphone applications in the medical field is increasingly evolving among
 healthcare professionals and patients. They allow for more personalized care, and can also
 promote interaction with health professionals.

 Strengthening the link between specialist doctors and the general practitioner for joint
 patient management will improve their follow-up and reduce the risk of iatrogeny.

 In 2016, a survey was conducted in the vascular medicine department of the Groupe Hospitalier
 Paris Saint-Joseph (GHPSJ) to assess access to smartphones among patients on anti-thrombotic
 medication. Of the 100 patients enrolled, 74 were on anticoagulant or platelet aggregation
 therapy. Of these, 50 had a mobile phone and 24% used the Internet and made downloads to
 their phones.

 This raises the question of the interest that patients might have in a mobile application on
 the use of anti-thrombotics. As the profile of patients seen in hospital is different from
 those consulting in general medicine, it seems interesting to study these two populations in
 order to know if there is a difference in their attitude towards the smartphone.

 In order to find a new way to limit the iatrogeny of antithrombotic drugs, the investigators
 wanted to set up a medical application (educational tablet) for patients to provide them with
 support to better manage their treatment.
Inclusion Criteria:

 -  Patient ≥ 18 years old

 -  Patient hospitalized in the vascular medicine department of the GHPSJ or attending a
 general medical consultation at the CMT

 -  Patient with at least one vascular pathology: pulmonary embolism, venous thrombosis or
 phlebitis, cardiac arrhythmia by atrial fibrillation, obliterating arteriopathy of the
 lower limbs or myocardial infarction

 -  Patient on antithrombotic treatment[anticoagulants : AVK or Anticoagulants Oraux
 Directs (AOD), or antiplatelet agents]

 -  Patient affiliated to a health insurance plan

 -  Patient able to read and understand the French language

 -  Patient capable of giving free, informed and express consent

 Exclusion Criteria:

 -  Patient not residing in Ile de France

 -  Patient whose investigator considers that he/she is not able to use a digital tablet

 -  Patient deprived of liberty

 -  Patient under guardianship or curatorship

 -  Refusal to participate in the study

 -  Patient judged not to be included by the investigator on the basis of the inclusion
 questionnaire