• Marc Ruivard, Christine Berger, Abdellaziz Achaibi, Claude Campagne, and Pierre Philippe.
• Service de Médecine Interne, Clermont-Ferrand, France. mruivard@chu-clermontferrand.fr
• J Gen Intern Med. 2003 Nov 1; 18 (11): 903907903-7.

ObjectiveOral anticoagulants (OA) are commonly used, but they can lead to severe bleeding. We studied the indications and monitoring of OA in patients treated by general practitioners.DesignRetrospective cross-sectional study.SettingPrimary care.PatientsFour hundred thirty-eight randomly selected patients of a population of 2,452 patients treated with OA were studied.InterventionsWe compared the indications for OA as reported by general practitioners with indications as defined according to recent guidelines.Main ResultsTwenty-five percent of patients should not have been treated with OA. Inappropriate indications (13% of patients) were atrial fibrillation without risk factor (3.9%), prior uncomplicated myocardial infarction (2.7%), peripheral arterial disease (2.7%), superficial thrombophlebitis (2.3%), and atherothrombotic ischemic stroke (1.6%). For 12% of patients, the duration of OA was too long (venous thromboembolism without permanent risk factor in 10%). Frequency of International Normalized Ratio (INR) measurement was insufficient for 14% of patients and target INR was not achieved in 31%.ConclusionsOur study demonstrated that clinicians' adherence to recommendations regarding indications for OA and management of this treatment should be improved. Implementation of anticoagulation clinics is probably needed.

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