Key result
Primary-care VKA therapy yields poor anticoagulation control, with only ~30% achieving target time in range.
Why the study?
In Poland, chronic oral anticoagulation with vitamin K antagonists is usually managed by primary care physicians, and this study sought to evaluate its effectiveness in a primary care practice.
Observational (n=104)
No
Answers are grounded in this paper and cite their sources.
Retrospective analysis reveals poor international normalised ratio control during chronic vitamin K antagonist treatment in primary care, indicating suboptimal real-world anticoagulation efficacy.
BACKGROUND: Oral anticoagulants reduce embolic complications in patients with atrial fibrillation (AF) and are used in the treatment and prevention of venous thromboembolism. In Poland, chronic oral anticoagulation is usually managed by primary care physicians, and the most commonly used drugs are vitamin K antagonists (VKA). AIM: To evaluate effectiveness of oral anticoagulation in 104 patients receiving chronic VKA treatment in primary care from Jan 01, 2011 to Dec 31, 2011. METHODS: We performed a retrospective analysis of data of 104 patients receiving chronic VKA treatment in a primary care practice (Niepubliczny Zakład Opieki Zdowotnej ESCULAP Gniewkowo) from Jan 01, 2011 to Dec 31, 2011. These patients comprised 1.1% of the population remaining under care of this primary care practice. We determined minimum, maximum and mean values of the international normalised ratio (INR), the proportion of results within the therapeutic range, the number of INR measurements, and indications for anticoagulant treatment. In patients with AF, we determined the risks of bleeding complications and thrombotic events. RESULTS: Among patients receiving chronic VKA treatment, 56.84% of INR measurements were within the therapeutic range. Only 29.8% of patients had more than 70% of INR measurements within the therapeutic range. We found no association between the number of INR measurements and treatment effectiveness. CONCLUSIONS: The effectiveness of anticoagulation in primary care is unsatisfactory. In our study population, an acceptable time in the therapeutic range was achieved in only just below 30% of patients.
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Dereziński et al. (2013) conducted an observational in Chronic oral anticoagulation indications (atrial fibrillation, venous thromboembolism, prosthetic heart valve) (n=104). Chronic vitamin K antagonist (VKA) therapy managed in primary care was evaluated on Proportion of patients achieving effective anticoagulation (defined as at least 70% of INR measurements within the therapeutic range).
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