Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Oct 25:15:170.
doi: 10.1186/s12875-014-0170-0.

Anticoagulant treatment in German family practices - screening results from a cluster randomized controlled trial

Lisa-R Ulrich  1 , Karola Mergenthal, Juliana J Petersen, Ina Roehl, Sandra Rauck, Birgit Kemperdick, Sylvia Schulz-Rothe, Andrea Berghold, Andrea Siebenhofer
Affiliations

Anticoagulant treatment in German family practices - screening results from a cluster randomized controlled trial

Lisa-R Ulrich et al. BMC Fam Pract. .

Abstract

Background: Oral anticoagulation (OAC) with coumarins and new anticoagulants are highly effective in preventing thromboembolic complications. However, some studies indicate that over- and under-treatment with anticoagulants are fairly common. The aim of this paper is to assess the appropriateness of treatment in patients with a long-term indication for OAC, and to describe the corresponding characteristics of such patients on the basis of screening results from the cluster randomized PICANT trial.

Methods: Randomly selected family practices in the federal state of Hesse, Germany, were visited by study team members. Eligible patients were screened using an anonymous patient list that was generated by the general practitioners' software according to predefined instructions. A documentation sheet was filled in for all screened patients. Eligible patients were classified into 3 categories (1: patients with a long-term indication for OAC and taking anticoagulants, 2: patients with a long-term indication for OAC but not taking anticoagulants, 3: patients without a long-term indication for OAC but taking an anticoagulant on a permanent basis). IBM SPSS Statistics 20 was used for descriptive statistical analysis.

Results: We screened 2,036 randomly selected, potentially eligible patients from 52 family practices. 275 patients could not be assigned to one of the 3 categories and were therefore not considered for analysis. The final study sample comprised 1,761 screened patients, 1,641 of whom belonged to category 1, 78 to category 2, and 42 to category 3. INR values were available for 1,504 patients of whom 1,013 presented INR values within their therapeutic ranges. The majority of screened patients had very good compliance, as assessed by the general practitioner. New antithrombotic drugs were prescribed in 6.1% of cases.

Conclusions: The screening results showed that a high proportion of patients were receiving appropriate anticoagulation therapy. The numbers of patients with a long-term indication for OAC therapy that were not receiving oral anticoagulants, and without a long-term indication that were receiving OAC, were considerably lower than expected. Most patients take coumarins, and the quality of OAC control is reasonably high.

Trial registration: Current Controlled Trials ISRCTN41847489.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The screening process in detail and the results of the screening.
See this image and copyright information in PMC

References

    1. Guyatt GH: Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines. Antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines.Chest 2012, 141:53S. - PMC - PubMed
    1. Hua TD, Vormfelde SV, Abed MA, Schneider-Rudt H, Sobotta P, Chenot JF. Orale Antikoagulation in der Hausarztpraxis. [Oral Anticoagulation Therapy in Family Medicine] Z Allg Med. 2010;10:382–389.
    1. Nabauer M, Gerth A, Limbourg T, Schneider S, Oeff M, Kirchhof P, Goette A, Lewalter T, Ravens U, Meinertz T, Breithardt G, Steinbeck G. The registry of the German competence NETwork on atrial fibrillation: patient characteristics and initial management. Europace. 2009;11:423–434. doi: 10.1093/europace/eun369. - DOI - PMC - PubMed
    1. Lip GY, Golding DJ, Nazir M, Beevers DG, Child DL, Fletcher RI. A survey of atrial fibrillation in general practice: the West Birmingham atrial fibrillation project. Br J Gen Pract. 1997;47:285–289. - PMC - PubMed
    1. Saal K, Hofmann B, Blauth E, Rohe J, Beyer M, Harder S, Gerlach FM. Analyse des Behandlungsprozesses bei der oralen Antikoagulationstherapie zur Identifikation von Sicherheitsproblemen in der hausärztlichen Versorgung [Identifying safety problems in the General Practice - analysis of the treatment process of oral anticoagulation therapy] Z Allg Med. 2009;85:148–155.

Publication types

MeSH terms

Associated data