Open AccessPhysician Compliance with Outpatient Oral Anticoagulant Guidelines in Auvergne, France
Author(s) -
Ruivard Marc,
Berger Christine,
Achaibi Abdellaziz,
Campagne Claude,
Philippe Pierre
Publication year - 2003
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1046/j.1525-1497.2003.21230.x
Subject(s) - medicine , atrial fibrillation , stroke (engine) , risk factor , population , superficial thrombophlebitis , outpatient clinic , myocardial infarction , retrospective cohort study , anticoagulant , thrombosis , warfarin , thrombophlebitis , emergency medicine , surgery , mechanical engineering , environmental health , engineering
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.