European Heart Journal Advance Access originally published online on April 4, 2006
European Heart Journal 2006 27(11):1382; doi:10.1093/eurheartj/ehi856
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The Belgian Improvement Study in Oral Anticoagulant Therapy: a randomized clinical trial
Pándy Kálmán Békés County Hospital
Gyula
Hungary
E-mail address: katona{at}pandy.hu
Pándy Kálmán Békés County Hospital
Gyula
Hungary
We read with great interest the article by Claes et al. about The Belgian Improvement Study on Oral Anticoagulant Therapy. The randomized clinical trial compares different interventional models to improve the quality of oral anticoagulant therapy in general practitioners' (GP's) practice who mainly manage the control of anticoagulation.1 In Hungary, arterial and venous vessel diseases have a great impact on morbidity and mortality data, so the quality of oral anticoagulation is essential.
Last year, we published a retrospective survey2 on the use of an oral anticoagulant, acenocoumarol, by specialists, mainly in outpatient departments (cardiology or general internal medicine) or GP's. We collected and analysed the data of 488 patients treated with this agent. The patients' mean age was 64.2±11.4 years. Most of them were treated for atrial fibrillation (42.8%) and venous thrombo-embolic events (29.7%). The mean value of all coagulation test results (INR: 2.72±1.07) suggested a relatively effective therapeutic quality. The accuracy of oral anticoagulant therapy was evaluated on the basis of the last three INR values. Patients were considered properly treated if their INR values were found to be between 2.5 and 3.5. In half of the patients, we detected INR values within the required range at least in two out of the three control lab tests. According to the guidelines on oral anticoagulation, >50% of results of the anticoagulation control should not deviate more than 0.5 INR unit from the target one.3 In our survey, 20% of the patients had their INR values outside the therapeutic limits. Forty per cent of these values were under 2.2 and 20% above 4.5, the latter group showing an increased risk for bleeding events. Data in the literature indicate that the risk of serious bleeding complications with acenocoumarol is 0.5–4.2%. In the Italian Study on Complication of Oral Anticoagulant Therapy, the frequency of serious bleeding events was found to be 1.1%.4 We had no patients with serious bleeding event and only 3.6% had a mild bleeding episode. Patients >70 years (n=195) had similar results to the average in therapeutic accuracy and in the safety data. At present, home self-control is not available in general practice, but we plan to introduce this method in the permanent anticoagulant therapy of selected patients. It is very important to emphasize the pivotal role of educating permanent patients. The paper of Claes et al. presents useful advise for improving the quality of anticoagulation performance.
References
- Claes N, Buntinx F, Vijgen J, Arnout J, Vermylen J, Fieuws S, Van London H. (2005) The Belgian Improvement Study in Oral Anticoagulant Therapy: a randomized clinical trial. Eur Heart J 26:2159–2165.
[Abstract/Free Full Text] - Katona A and Mark L. (2004) A retrospective survey on practice of oral anticioagulant therapy in patients with cardiovascular diseases. Orv Hetil (Hungarian Medical Weekly) 32:1643–1647.
- Guidelines on oral anticoagulant therapy: third edition. Br J Haematol (1998) 101:374–387.[CrossRef][Medline]
- Palareti G, Leali N, Coccheri S, Poggi M, Manotti C, D'Angelo A, Pengo V, Erba N, Moia M, Ciavarella N, Devoto G, Berrettini M, Musolesi S. (1996) Bleeding complication of oral anticoagulant therapy: an inception-cohort prospective collaboration study (ISCOAT). Lancet 348:423–428.[CrossRef][Web of Science][Medline]
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