[VKA anticoagulant bridging for an invasive procedure or planned surgery: A survey of practices in general practitioners].
BACKGROUND
In 2011, 1.7 % of the French population was receiving a Vitamine K Antagonist (VKA) anticoagulant therapy. VKA related adverse events are the first cause for iatrogenic events in France. Anticoagulant bridging period is a period at both increased risk for thromboembolic and bleeding events. The Haute Autorité de santé (HAS) established in 2008 recommendations in order to help physicians to manage anticoagulant therapy in case of invasive procedure or surgery, according to the procedure and the indication of VKA.


OBJECTIVE
To assess anticoagulant treatment management by general physicians when an invasive procedure or a planned surgery in a patient receiving long-term VKA Data have been compared to HAS recommendations.


METHODS
A descriptive transversal survey performed in general physicians à at the conference held in Nice in 2012. An anonymous questionnaire was built, including questions about clinical situations and knowledge questions.


RESULTS
Eighty-eight out of 200 submitted questionnaires have been completed (44%). Overall, 4.5% of questioned physicians have managed fully in accordance with HAS recommendations the 6 clinical situations cliniques about patients receiving long-term VKA for atrial fibrillation, recurrent pulmonary embolism, and mechanical valvular prothesis. Bridgings using Low Molecular Weight Heparins have been excessively proposed by asked physicians and bridging prescription was most of the time wrong (9% correct). Otherwise, no physician has answered correctly all theoretical questions; patients at high and low thromboembolic risk are not well distinguished; 64% of physicians think they are influenced by specialists who have prescribed the procedure.


CONCLUSIONS
Few physicians manage VKA therapy in accordance with HAS recommendations in case of invasive procedure. There are many hypotheses: bad knowledge of recommendations, overestimation of the thromboembolic risk related to VKA stopping during the period of the invasive procedure, underestimation of the risk of bleeding related to the bridging period of time; influence of specialists. We propose a decisional algorithm in order to improve the implementation of HAS recommendations in usual care.
AP-HP, université Paris 7, Paris Diderot, Sorbonne Paris Cité, EA Recherche clinique, coordonnée ville-hôpital, Méthodologies et Société (REMES), hôpital Louis-Mourier, service de médecine interne, 92700 Colombes, France.
Florent
F
Bavozet
AP-HP, université Paris 7, Paris Diderot, Sorbonne Paris Cité, EA Recherche clinique, coordonnée ville-hôpital, Méthodologies et Société (REMES), hôpital Louis-Mourier, service de médecine interne, 92700 Colombes, France. Electronic address: isabelle.mahe@lmr.aphp.fr.
Isabelle
I
Mahé
D000465:Algorithms; D000925:Anticoagulants / Q000627:therapeutic use*; D058006:General Practice; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D010818:Practice Patterns, Physicians'; D013514:Surgical Procedures, Operative; D013923:Thromboembolism / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D014812:Vitamin K