Physician compliance with outpatient oral anticoagulant guidelines in Auvergne, France.

Abstract

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. Retrospective cross-sectional study. Primary care. Four hundred thirty-eight randomly selected patients of a population of 2,452 patients treated with OA were studied. We compared the indications for OA as reported by general practitioners with indications as defined according to recent guidelines. 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%. 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.