Quality evaluation of the management of oral anticoagulation therapy (OAT): the awareness of treating physicians and the education of patients needs to be improved.

The adverse effects of oral anticoagulant therapy (OAT) are the main cause of hospitalization for drug accidents, and most of them could be avoided by more rigorous management. We conducted a prospective study based on the analysis of individuals under OAT recruited among the patients admitted to our hospital. The aim was to evaluate the legitimacy of OAT and the quality of its management by referring to general recommendations. Eighty-six patients were included. In 10, the disease justifying OAT was not included in the French recommendations. Contraindications to OAT were observed in 5 patients. Six drug associations were dangerous. The day of admission, the INR value was beyond the therapeutic range in 27 patients and under in 27 patients. Nine patients had been admitted to the hospital for an adverse effect of OAT (hemorrhage or thrombotic event). The risk of adverse effects was higher when the indications of OAT were outside the recommendations, when a contraindication to OAT existed, or when OAT had been prescribed beyond the necessary duration. A low number of patients knew their INR target, the risks of over- and under-anticoagulation, and the dangers of consuming certain drugs and foods. The overall risk linked to OAT would be diminished if the treatment was prescribed within the legitimate indications and the necessary duration, and taking greater account of the contraindications. The awareness of physicians prescribing OAT needs improvement. The lack of knowledge of the treatment by the patient him- or herself, which may be due to a lack of information or to a misunderstanding, should be counterbalanced by a reinforced education, even if it is time-consuming for the physician.

[Assessment of the quality of oral anticoagulation management in patients admitted to Amiens University Hospital]. / Evaluation à l'occasion de leur hospitalisation de la qualité de l'anticoagulation orale chez des patients traités par antivitamines K.

BACKGROUND: Excessive or insufficient anticoagulation therapy and its associated risks are of major concern in patients receiving oral anticoagulants. Such complications can be avoided by more rigorous management. OBJECTIVE: The aim of our study was to evaluate those patients receiving oral anticoagulant therapy on the day of hospitalisation among all patients admitted to the Amiens University Hospital during 14 days. METHODS: We evaluated the quality of management of the treatment in these patients, taking into account the international normalised ratio (INR), as well as important parameters such as the summary of the product characteristics (SPCs), drug interactions, and the level of knowledge of anticoagulant treatment by the patients themselves (questionnaire). RESULTS: Of the 2498 adult patients hospitalised, 86 patients (30 female and 56 male aged between 26 and 95 years [mean 70 years]) treated with oral anticoagulants were evaluated. At admission, seven cases of haemorrhage and two of thrombosis were registered. One drug-related death occurred and one patient had sequelae. In 17.5% of the cases, the prescription was not fully in agreement with the SPCs. This percentage increased to 67% for patients with adverse effects. In 41% of the patients, the INR was outside the therapeutic zone. The dosage regimen was too complex in 11% of cases. Six drug combinations were labelled as not recommended in the SPCs: four with aspirin <3 g/day and two with nonsteroidal anti-inflammatory drugs. The analysis of questionnaires showed that patients had insufficient knowledge of their treatment: only 16 of 66 knew the risks resulting from overdose or an insufficient dose of the anticoagulant drug, 25 of 66 knew that anticoagulation induced by the treatment can be influenced by food, 10 of 66 knew the therapeutic range of the INR appropriate for them, and 8 of 66 knew that intramuscular injections were prohibited. CONCLUSIONS: These data confirm that anticoagulant treatment needs to be more strictly controlled in order to avoid adverse effects. Risks are probably underestimated by physicians. Information given to patients seems insufficient or unsuitable (too complex).