title: [Anticoagulant clinics are they effective in France? Performance evaluation of six anticoagulant clinics concerning the management of vitamin K antagonists].
abstract: OBJECTIVE
  Recent data show that the quality of anticoagulation evaluated in patients receiving vitamin K antagonists (VKA) is not optimal in France. The aim of this retrospective study was to estimate the performances of six French anticoagulant clinics that manage VKA treatments over a 3-year period, from 2009 to 2011.
  
  
  METHODS
  All clinics used the same rule based software. We determined the time spent in the therapeutic range (TTR), a surrogate end-point of quality of treatment with VKA.
  
  
  RESULTS
  The overall duration of follow-up was 2755 patient-years concerning 2385 patients. The time spent in the therapeutic range 2 to 3 assigned for 89% of the patients, was 73%. On the other hand the time spent in the therapeutic range for the other two INR ranges (2.5-3.5 and 3-4.5) concerning 11% of patients with prosthetic heart valve was lower (63.7% and 68.8% respectively) with an imbalance in favour of the time below the range. In this study, warfarin (Coumadine(®)) and fluindione (Previscan(®)) allowed an equivalent quality of anticoagulation. The 1728 patients of age ranged from 60 to 100 years spent more time in TTR than the 651 younger patients. The percentage of time spent with an INR greater than 5 was extremely reduced which is a guarantee of safety.
  
  
  CONCLUSIONS
  These results prove that anticoagulant clinics in France have the same good performances as their counterparts abroad. It can be assumed that a high TTR contributes to a low incidence of both bleedings and thrombosis.
authors.affiliation: Laboratoire d'hématologie, hôpital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France. cambus.jp@chu-toulouse.fr
authors.forename: J P
authors.initials: JP
authors.lastname: Cambus
authors.forename: D
authors.initials: D
authors.lastname: Magnin
authors.forename: C
authors.initials: C
authors.lastname: Ambid-Lacombe
authors.forename: A
authors.initials: A
authors.lastname: Bura
authors.forename: F
authors.initials: F
authors.lastname: Desgrippes
authors.forename: J M
authors.initials: JM
authors.lastname: Schneller
authors.forename: Y
authors.initials: Y
authors.lastname: Benhamou
authors.forename: C
authors.initials: C
authors.lastname: Flaujac
authors.forename: M H
authors.initials: MH
authors.lastname: Horellou
authors.forename: E
authors.initials: E
authors.lastname: De Raucourt
authors.forename: D
authors.initials: D
authors.lastname: Kaczan
authors.forename: J M
authors.initials: JM
authors.lastname: Astoul
authors.forename: V
authors.initials: V
authors.lastname: Siguret
mesh_terms: D015110:4-Hydroxycoumarins / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007192:Indenes / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011364:Professional Practice; D012189:Retrospective Studies; D014812:Vitamin K / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D015110:4-Hydroxycoumarins; D000925:Anticoagulants; D007192:Indenes; C011664:antivitamins K; D014812:Vitamin K
keywords: Acenocoumarol; Acénocoumarol (Sintrom(®)); Anticoagulant clinic; Clinique d’anticoagulant; Computerised dosing system; Fluindione; Fluindione (Préviscan(®)); Logiciel d’aide à la prescription; Warfarin; Warfarine (Coumadine(®))