title: [Comparison of platelet monitoring in patients receiving thromboprophylaxis with fondaparinux or a low molecular weight heparin. The Ariane study].
abstract: OBJECTIVE
  To describe and compare the conditions of use of fondaparinux and low molecular weight heparin (LMWH) in the prevention of venous thromboembolism in routine general practice with a focus on platelet monitoring.
  
  
  METHODS
  This was an observational and pharmaco-epidemiological survey, performed in France in general practice in adult patients receiving thromboprophylaxis with fondaparinux or a LMWH. The study collected data on medical conditions justifying thromboprophylaxis, reasons for platelet monitoring and type of prescription.
  
  
  RESULTS
  Four hundred and seventy general practioners included 837 analysable patients (450 treated with fondaparinux and 387 with LMWH). In the fondaparinux group, the mean age was 61.5±17.3 and 259 (57.6 %) patients were women. In the LMWH group, the mean age was 61.7±17.8 and 205 (53.0 %) patients were women. The reasons of prescribing were: bedridden related to a severe acute medical illness in 255 (56.7 %) patients with fondaparinux and 244 (63.1 %) with LMWH, and reduction of mobility associated with trauma without fracture respectively in 121 (26.9 %) and 85 (22.0 %) of patients. Associated risk factors were varicose veins, obesity and a history of thrombosis. Platelet monitoring was prescribed in 168 (37.6 %) patients treated with fondaparinux. In this group, these prescription were considered "appropriate" in 94 (20.9 %) patients, of whom 76 (16.9 %) were monitored for screening purposes, and "not appropriate" in 67 (14.9 %) patients, because prescribed to monitor thrombo-prophylaxis. In the LMWH group, a platelet count was prescribed in 370 (96.1 %) patients, of whom 312 (81.0 %) receiving a prescription only in order to monitor thromboprophylaxis.
  
  
  CONCLUSIONS
  The results provided in the Ariane study were coherent with literature data (Etape and Depart studies). In comparison with the CNAM study, which evaluated prescription practices for LMWH in thromboprophylaxis in France in 1999, and which reported a global rate of platelet monitoring of 70.0 %, the rate reported in the Ariane study (81.0 %) seems to represent an improvement in the practice standards. Since 2009, Afssaps does not recommend a systematic monitoring with LMWH at acute or prophylactic dose, outside a post surgical context or in case of pre-treatment with unfractionated heparin.
  
  
  CONCLUSIONS
  The Ariane study provides important information on platelet monitoring in patients treated with fondaparinux or LMWH, and also on thromboprohylaxis in general practice.
authors.affiliation: Hôpital Hôtel-Dieu (AP-HP), université Paris-Descartes Inserm U 765, 75181 Paris cedex 04, France. isabelle.gouin@htd.ap-hop-paris.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gouin-Thibault
authors.forename: François
authors.initials: F
authors.lastname: Liard
authors.forename: Eric
authors.initials: E
authors.lastname: Van-Ganse
authors.forename: Laurent
authors.initials: L
authors.lastname: Vespa
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Gaudin
authors.forename: Fatima
authors.initials: F
authors.lastname: Nachit-Ouinekh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D000077425:Fondaparinux; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011134:Polysaccharides / Q000009:adverse effects / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D011134:Polysaccharides; D000077425:Fondaparinux