Ulrich Lisa-R, Mergenthal Karola, Petersen Juliana J, Roehl Ina, Rauck Sandra, Kemperdick Birgit, Schulz-Rothe Sylvia, Berghold Andrea, Siebenhofer Andrea
Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany.
BMC Fam Pract. 2014 Oct 25;15:170. doi: 10.1186/s12875-014-0170-0.
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.
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.
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.
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.
Current Controlled Trials ISRCTN41847489.
使用香豆素类药物及新型抗凝剂进行口服抗凝治疗（OAC）在预防血栓栓塞并发症方面具有很高的疗效。然而，一些研究表明，抗凝治疗过度和不足的情况相当常见。本文旨在评估长期需要OAC治疗的患者的治疗合理性，并根据整群随机PICANT试验的筛查结果描述此类患者的相应特征。
研究团队成员走访了德国黑森州随机选取的家庭诊所。符合条件的患者通过由全科医生软件根据预定义指令生成的匿名患者名单进行筛查。为所有筛查患者填写一份记录单。符合条件的患者被分为3类（1：有长期OAC治疗指征且正在服用抗凝剂的患者；2：有长期OAC治疗指征但未服用抗凝剂的患者；3：无长期OAC治疗指征但长期服用抗凝剂的患者）。使用IBM SPSS Statistics 20进行描述性统计分析。
我们从52家家庭诊所筛查了2036名随机选取的、可能符合条件的患者。275名患者无法归入这3类中的任何一类，因此未纳入分析。最终的研究样本包括1761名筛查患者，其中1641名属于第1类，78名属于第2类，42名属于第3类。1504名患者有国际标准化比值（INR）值，其中1013名患者的INR值在治疗范围内。根据全科医生的评估，大多数筛查患者的依从性非常好。6.1%的病例中开具了新型抗血栓药物。
筛查结果显示，很大一部分患者正在接受适当的抗凝治疗。有长期OAC治疗指征但未接受口服抗凝剂治疗的患者数量，以及无长期OAC治疗指征但接受OAC治疗的患者数量，均远低于预期。大多数患者服用香豆素类药物，OAC控制质量相当高。
当前受控试验ISRCTN41847489 。
