Utilisation des héparines en médecine de ville : données de l’Assurance Maladie de Midi-Pyrénées

Abstract

The risk of haemorrhagic complications associated with heparin therapy can be reduced by good clinical practice. The aim of this study was to describe outpatient heparin therapy by using the database of the national health fund. The study population consisted of affiliates of the salaried employees insured by the health fund branch of the Midi-Pyrénées region, and corresponded to 62% of the residents of that region. Analysis of treatments and biological monitoring was carried out on a 1-year period. During this period, 16 462 patients started a treatment with heparin, 92% for a single treatment. The mean age of the patients was 55years (SD=19.8) and the majority were women (53%). Nine percent of these patients were switched to oral anticoagulant therapy. Of the other patients, 52% received heparin for less than 10days, 36% for between 10days and 5weeks, and 12% for more than 5weeks; 33% of the last group where heparin was prescribed for more than 5weeks corresponds to a prescription of more than 3months. Seventy-three percent of the heparin treatment durations complied with the authorities’ (l’Agence française de sécurité sanitaire des produits de santé [Afssaps]) recommendations. Biological monitoring comprised a platelet count, an APTT (activated partial thromboplastin time) or an anti-Xa check in 41.9%, 27.8% and 3.1% of treated patients, respectively. Creatininaemia was measured in 27% of patients aged >75years (a group at increased risk of adverse drug reactions). Even considering some of the differences noted between the medical prescriptions and the reimbursement data of the health fund, results from this study allowed an evaluation of medical practices and suggests that monitoring of patients receiving heparin treatments remains insufficient, thus decreasing the benefit/risk ratio of such therapies.