Rafael Alonso Roca1, Carmen Arlene Figueroa Guerrero2, Victoria Mainar de Paz3, M Paz Arribas García4, Luis Sánchez Perruca5, Ricardo Rodríguez Barrientos6, Mariano Casado López5, Ana M Pedraza Flechas7. 1. Centro de Salud Griñón, Área Sur, Madrid, España. Electronic address: alonsorocarafael@gmail.com. 2. Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España. 3. Médico de familia y residente Psiquiatría, Instituto Psiquiátrico José Germain, Leganés, Madrid, España. 4. Médico de familia, Centro de Salud Maqueda, Área Centro, Madrid, España. 5. Médico de familia, Dirección Técnica de Sistemas de Información, Gerencia Adjunta de Planificación y Calidad, Gerencia de Atención Primaria, Madrid, España. 6. Médico de familia, Unidad de Apoyo a la Investigación, Gerencia Adjunta de Planificación y Calidad, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España. 7. Especialista en Medicina Preventiva, Hospital Central de la Defensa Gómez Ulla, Madrid, España.
Abstract
OBJECTIVES: To determine quality control of patients with oral anticoagulant treatment recruited in Primary Care (PC) using the Rosendaal method to estimate time in therapeutic range (TTR) and comparing it with fraction of international normalized ratio (INR) in range and cross-sectional analysis (last INR registred). MATERIAL AND METHOD: A retrospective observational study based on electronic medical record in routine clinical practice. SETTING: PC centers (262) in Madrid. We included all patients with acenocumarol treatment, with an INR therapeutic range established between 2 and 3. We excluded patients with valvular pathology and disrupted clinical follow up in PC (<3 INR determinations in the studied period, a period of>90 days or ≥ 3 periods of>60 days between 2 determinations). The final population was 49,312 patients. The variables considered were all INR values and their respective dates. TTR was calculated by the 3 methods above mentioned. We considered "therapeutic range" INR between 2-3 and "adjusted range" INR between 1.8-3.2. Optimal control for each patient was considered TTR>60%. RESULTS: By using Rosendaal method, TTR was 66.8% (81.7% adjusted), with a percentage of total INR in range was 58.8% (66.5% adjusted), and, with the cross-sectional analysis, it was 70.5% (76.8% adjusted). Mean TTR was 65% (standard deviation 20.3), and the percentage of patients with TTR>60% was 63.3% (88.1% adjusted). CONCLUSION: The quality control of patients with oral anticoagulants in PC in Madrid is acceptable, similar or higher to other studies and pivotal trials of new anticoagulants. Compared to the Rosendaal method, total fraction of INR underestimates quality control, and cross-sectional analysis slightly overestimates it.
OBJECTIVES: To determine quality control of patients with oral anticoagulant treatment recruited in Primary Care (PC) using the Rosendaal method to estimate time in therapeutic range (TTR) and comparing it with fraction of international normalized ratio (INR) in range and cross-sectional analysis (last INR registred). MATERIAL AND METHOD: A retrospective observational study based on electronic medical record in routine clinical practice. SETTING: PC centers (262) in Madrid. We included all patients with acenocumarol treatment, with an INR therapeutic range established between 2 and 3. We excluded patients with valvular pathology and disrupted clinical follow up in PC (<3 INR determinations in the studied period, a period of>90 days or ≥ 3 periods of>60 days between 2 determinations). The final population was 49,312 patients. The variables considered were all INR values and their respective dates. TTR was calculated by the 3 methods above mentioned. We considered "therapeutic range" INR between 2-3 and "adjusted range" INR between 1.8-3.2. Optimal control for each patient was considered TTR>60%. RESULTS: By using Rosendaal method, TTR was 66.8% (81.7% adjusted), with a percentage of total INR in range was 58.8% (66.5% adjusted), and, with the cross-sectional analysis, it was 70.5% (76.8% adjusted). Mean TTR was 65% (standard deviation 20.3), and the percentage of patients with TTR>60% was 63.3% (88.1% adjusted). CONCLUSION: The quality control of patients with oral anticoagulants in PC in Madrid is acceptable, similar or higher to other studies and pivotal trials of new anticoagulants. Compared to the Rosendaal method, total fraction of INR underestimates quality control, and cross-sectional analysis slightly overestimates it.
Keywords:
Anticoagulantes; Anticoagulants; Atención Primaria; Grado de control; International normalized ratio; Primary Care; Quality control; Razón normalizada internacional
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