, Volume 18, Issue 11, pp 903-907

Physician compliance with outpatient oral anticoagulant guidelines in Auvergne, France

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Abstract

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.