Outpatient oral anticoagulant management--an audit of 82 patients.
OBJECTIVE
Use of oral anticoagulants for thrombotic diseases has been increasing steadily over the years. Management practices however, are far from uniform. We conducted a retrospective audit among outpatients on oral anticoagulant therapy to assess treatment practices and overall control of anticoagulation.


METHODS
Case records of 82 patients who were on anticoagulant therapy for a minimum duration of three months were reviewed. Information on pre-therapeutic assessment of patients, therapeutic control and complications seen during the course of treatment was recorded.


RESULTS
Case notes of 43 males and 39 females with a mean age of 47.5 +/- 14.6 years, on oral anticoagulant treatment were evaluated. Treatment duration ranged from 3 months to 7 years for a total of 258.7 patient treatment years. Pre-therapeutic assessment of patients was inadequate with only baseline hematological and renal parameters available for most patients. Of a total of 1631 prothrombin time ratios and International Normalized Ratios recorded, only 17.8% were in the therapeutic range with 73% being sub-therapeutic. Sixteen (19.5%) patients had treatment related complications. The number of thrombotic and hemorrhagic events per 100 patient treatment years was 3.4 and 2.7 respectively.


CONCLUSIONS
Pre-therapeutic assessment of patients was inadequate. The overall therapeutic control was poor with patients in a state of underanticoagulation for most period of anticoagulant treatment. The complication rate was also unacceptably high. There is a need to reassess management practices of patients on long term oral anticoagulation with strict adherence to standard accepted guidelines to make this therapy more effective and safer for patients.
Kakkar
N
N
Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab.
Kaur
R
R
John
Mary
M
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000925:Anticoagulants / Q000627:therapeutic use*; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000592:standards*
D000925:Anticoagulants