title: Physician compliance with outpatient oral anticoagulant guidelines in Auvergne, France.
abstract: OBJECTIVE
  Oral 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.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  Primary care.
  
  
  METHODS
  Four hundred thirty-eight randomly selected patients of a population of 2,452 patients treated with OA were studied.
  
  
  METHODS
  We compared the indications for OA as reported by general practitioners with indications as defined according to recent guidelines.
  
  
  RESULTS
  Twenty-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%.
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Service de Médecine Interne, Clermont-Ferrand, France. mruivard@chu-clermontferrand.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Ruivard
authors.forename: Christine
authors.initials: C
authors.lastname: Berger
authors.forename: Abdellaziz
authors.initials: A
authors.lastname: Achaibi
authors.forename: Claude
authors.initials: C
authors.lastname: Campagne
authors.forename: Pierre
authors.initials: P
authors.lastname: Philippe
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants