[Oral anticoagulants in clinical practice]

Abstract

Oral anticoagulation (OA) in ambulatory practice is a controversial issue, and the efficacy and safety of its performance is an essential condition for the use of such sophisticated therapy in this setting. The efficacy and use of OA was studied in 24 participating practices over one year (1.4 1987 to 31.3. 1988). Overall, 538 patients were treated by OA, accounting for 22.4 patients/medical practice. OA was initiated in 207 patients, while 287 patients were on longterm (greater than 2 years) anticoagulation therapy. Most patients had polymorbidity, and many presented several indications for OA. On average, thromboplastin time was determined 2.7 times in the first 2 weeks of therapy and every 21 days during the whole period. 72% of measured thromboplastin times were within the target and 90.6% within the therapeutic range. Bleeding complications occurred in 38 patients (7.6%; 11.6/100 treatment years). OA had to be interrupted only 14 times (2.6%; 4.3/100 treatment years), and 7 patients (2.3%; 2.3/100 treatment years) were admitted to hospital. 6 patients died, as compared with 7.5 deaths expected from national mortality rates; none died from complications of OA. Based on these results it can be concluded that OA was highly effective in the 24 participating practices and had a low rate of complications.