Key result
Oral anticoagulation therapy shows ~93% appropriate use among screened primary care patients.
Why the study?
Over- and under-treatment with oral anticoagulants are fairly common despite their effectiveness in preventing thromboembolic complications, necessitating assessment of treatment appropriateness.
Cross-Sectional (n=1,761)
Cluster
Yes
Screening in German family practices reveals a high rate of appropriate oral anticoagulation prescribing and good INR control among patients with long-term indications.
High appropriateness of OAC in German family practices supports guideline adherence; leaves open generalizability to other settings and populations.
BACKGROUND: Oral anticoagulation (OAC) with coumarins and new anticoagulants are highly effective in preventing thromboembolic complications. However, some studies indicate that over- and under-treatment with anticoagulants are fairly common. The aim of this paper is to assess the appropriateness of treatment in patients with a long-term indication for OAC, and to describe the corresponding characteristics of such patients on the basis of screening results from the cluster randomized PICANT trial. METHODS: Randomly selected family practices in the federal state of Hesse, Germany, were visited by study team members. Eligible patients were screened using an anonymous patient list that was generated by the general practitioners' software according to predefined instructions. A documentation sheet was filled in for all screened patients. Eligible patients were classified into 3 categories (1: patients with a long-term indication for OAC and taking anticoagulants, 2: patients with a long-term indication for OAC but not taking anticoagulants, 3: patients without a long-term indication for OAC but taking an anticoagulant on a permanent basis). IBM SPSS Statistics 20 was used for descriptive statistical analysis. RESULTS: We screened 2,036 randomly selected, potentially eligible patients from 52 family practices. 275 patients could not be assigned to one of the 3 categories and were therefore not considered for analysis. The final study sample comprised 1,761 screened patients, 1,641 of whom belonged to category 1, 78 to category 2, and 42 to category 3. INR values were available for 1,504 patients of whom 1,013 presented INR values within their therapeutic ranges. The majority of screened patients had very good compliance, as assessed by the general practitioner. New antithrombotic drugs were prescribed in 6.1% of cases. CONCLUSIONS: The screening results showed that a high proportion of patients were receiving appropriate anticoagulation therapy. The numbers of patients with a long-term indication for OAC therapy that were not receiving oral anticoagulants, and without a long-term indication that were receiving OAC, were considerably lower than expected. Most patients take coumarins, and the quality of OAC control is reasonably high. TRIAL REGISTRATION: Current Controlled Trials ISRCTN41847489.
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Ulrich et al. (2014) conducted a cross-sectional in Long-term indication for oral anticoagulation (n=1,761). Oral anticoagulation therapy vs. No oral anticoagulation therapy was evaluated on Appropriateness of oral anticoagulation therapy (proportion of patients with a long-term indication receiving OAC). Among screened patients in German family practices, 93.2% received appropriate oral anticoagulation therapy, with only 4.4% under-treated and 2.4% over-treated.
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