title: Outcome of coumarin-therapy in an outpatient setting over a 10-year period: coumarin-therapy in clinical practice.
abstract: OBJECTIVE
  A retrospective study was conducted on an unselected sample of patients on vitamin K antagonists (VKAs; phenprocoumon, acenocoumarol) in an outpatient setting in Austria. The main objective was to determine whether bleeding and thromboembolic events reported in randomised trials are comparable to the experience in clinical practice. In addition, we focused on differences between the two VKAs and the particular indications for treatment and influences of risk factors.
  
  
  METHODS
  Total observation time was 10 years, the number of patients was 599 and the patient years-at-risk (pyr) was 1,856.
  
  
  RESULTS
  Severe bleeding occurred in 1.1 % pyr and the bleeding-related mortality was 0.1 %. Severe thromboembolic events occurred in 2.8 % pyr, with a rate of fatal events of 0.3 %. A significant increase in risk was found in patients older than 75 years concerning bleeding as well as thromboembolic events. Acenocoumarol showed significantly higher rates in life-threatening and fatal bleeding episodes in comparison to phenprocoumon.
  
  
  CONCLUSIONS
  The outcome of patients receiving VKA in an office setting is similar to that reported in the literature and the use of VKAs in this setting appears to be safe.
authors.affiliation: Department of Psychiatry, Medical University Graz, Auenbruggerplatz 31, 8036 Graz, Austria. eva.schmidt@medunigraz.at
authors.forename: Eva Z
authors.initials: EZ
authors.lastname: Reininghaus
authors.forename: Harald
authors.initials: H
authors.lastname: Schmidt
authors.forename: Ingrid
authors.initials: I
authors.lastname: Lafer
authors.forename: Georg
authors.initials: G
authors.lastname: Gutjahr
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Schmidt
authors.forename: Bernd
authors.initials: B
authors.lastname: Reininghaus
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Kapfhammer
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Stepan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000925:Anticoagulants / Q000627:therapeutic use; D001317:Austria / Q000453:epidemiology; D015897:Comorbidity; D003374:Coumarins / Q000627:therapeutic use*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003374:Coumarins; C030123:coumarin