OBJECTIVE: Oral anticoagulants (OA) are commonly used, but they can lead to severe bleeding. We studied the indications and monitoring of OA in patients treated by general practitioners. DESIGN: Retrospective cross-sectional study. SETTING: Primary care. PATIENTS: Four hundred thirty-eight randomly selected patients of a population of 2,452 patients treated with OA were studied. INTERVENTIONS: We compared the indications for OA as reported by general practitioners with indications as defined according to recent guidelines. MAIN RESULTS: Twenty-five percent of patients should not have been treated with OA. Inappropriate indications (13% of patients) were atrial fibrillation without risk factor (3.9%), prior uncomplicated myocardial infarction (2.7%), peripheral arterial disease (2.7%), superficial thrombophlebitis (2.3%), and atherothrombotic ischemic stroke (1.6%). For 12% of patients, the duration of OA was too long (venous thromboembolism without permanent risk factor in 10%). Frequency of International Normalized Ratio (INR) measurement was insufficient for 14% of patients and target INR was not achieved in 31%. CONCLUSIONS: Our study demonstrated that clinicians' adherence to recommendations regarding indications for OA and management of this treatment should be improved. Implementation of anticoagulation clinics is probably needed.
OBJECTIVE: Oral anticoagulants (OA) are commonly used, but they can lead to severe bleeding. We studied the indications and monitoring of OA in patients treated by general practitioners. DESIGN: Retrospective cross-sectional study. SETTING: Primary care. PATIENTS: Four hundred thirty-eight randomly selected patients of a population of 2,452 patients treated with OA were studied. INTERVENTIONS: We compared the indications for OA as reported by general practitioners with indications as defined according to recent guidelines. MAIN RESULTS: Twenty-five percent of patients should not have been treated with OA. Inappropriate indications (13% of patients) were atrial fibrillation without risk factor (3.9%), prior uncomplicated myocardial infarction (2.7%), peripheral arterial disease (2.7%), superficial thrombophlebitis (2.3%), and atherothrombotic ischemic stroke (1.6%). For 12% of patients, the duration of OA was too long (venous thromboembolism without permanent risk factor in 10%). Frequency of International Normalized Ratio (INR) measurement was insufficient for 14% of patients and target INR was not achieved in 31%. CONCLUSIONS: Our study demonstrated that clinicians' adherence to recommendations regarding indications for OA and management of this treatment should be improved. Implementation of anticoagulation clinics is probably needed.
Authors: J B Segal; R L McNamara; M R Miller; N Kim; S N Goodman; N R Powe; K A Robinson; E B Bass Journal: J Gen Intern Med Date: 2000-01 Impact factor: 5.128
Authors: N Levitan; A Dowlati; S C Remick; H I Tahsildar; L D Sivinski; R Beyth; A A Rimm Journal: Medicine (Baltimore) Date: 1999-09 Impact factor: 1.889
Authors: G Belcaro; A N Nicolaides; B M Errichi; M R Cesarone; M T De Sanctis; L Incandela; R Venniker Journal: Angiology Date: 1999-07 Impact factor: 3.619
Authors: Paul M Ridker; Samuel Z Goldhaber; Ellie Danielson; Yves Rosenberg; Charles S Eby; Steven R Deitcher; Mary Cushman; Stephan Moll; Craig M Kessler; C Gregory Elliott; Rolf Paulson; Turnly Wong; Kenneth A Bauer; Bruce A Schwartz; Joseph P Miletich; Henri Bounameaux; Robert J Glynn Journal: N Engl J Med Date: 2003-02-24 Impact factor: 91.245