Direct oral anticoagulants (DOACs) have become for a few years an alternative to the use of vitamin K antagonists (VKA) as oral anticoagulant strategy to treat acute pulmonary embolism(PE). However, data in routine clinical practice are needed.

We conducted a prospective multicentre multidisciplinary registry study to show baseline characteristics of patients treated with DOACs in acute PE, to identify factors that independently influence therapeutic decision to prescribe or not DOACs and to analyse factors of inappropriate prescription of DOACs.

We included all patients discharged with the objectively confirmed diagnosis of acute PE in 10 centres in Franche-Comté and Burgundy for 4years. Participating centres were 5 cardiology departments but also Intensive Care Unit, Oncology, Orthopaedic surgery and Internal medicine departments.

Between September 2012 and December 2016, 1157 patients were enrolled from 10 centres. Among discharged patients (n=1113), 61.7% (n=687) were treated with DOACs and 38.3% (n=426) with another or no anticoagulant. Those who received DOACs had less comorbidities, a lower cardiac biomarkers and plasmatic creatinine level and a lower early mortality risk. Prescription frequency of DOACs increased from 2012 to 2016. An older age (OR=0.76 (0.66–0.88), P<0.001), a chronic kidney disease with creatinine clearance inferior to 30mL/mn (OR 0.24 (0.11–0.42), P<0.001), an active cancer (OR=0.016 (0.008–0.03), P<0.001) and an in-hospital bleeding (OR=0.27 (0.12–0.59), P<0.001) are strong predicting factors in favour of non-prescription of DOAC. A cardiological centre hospitalization is a predictor of the decision to prescribe DOACs (OR=4.8 (3.3–6.8), P<0.001).

Our registry shows that DOACS are already used regularly in daily clinical practice for acute PE treatment with a progressive increased rate of DOACs prescription with more than 60% of patients receiving DOACs in our registry.