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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.

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Authors and Affiliations

  1. Service de Médecine Interne CHU Hôtel-Dieu, 11, Bd Léon Malfreyt, 63000, Clermont-Ferrand, France

    Marc Ruivard MD, Abdellaziz Achaibi MD, Claude Campagne MD & Pierre Philippe MD

  2. MSA 63, Clermont-Ferrand, France

    Christine Berger MD

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  1. Marc Ruivard MD
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  2. Christine Berger MD
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  3. Abdellaziz Achaibi MD
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  4. Claude Campagne MD
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Correspondence to Marc Ruivard MD.

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Ruivard, M., Berger, C., Achaibi, A. et al. Physician compliance with outpatient oral anticoagulant guidelines in Auvergne, France. J GEN INTERN MED 18, 903–907 (2003). https://doi.org/10.1046/j.1525-1497.2003.21230.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.21230.x

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