title: Primary care monitoring of patients under oral anticoagulation.
abstract: OBJECTIVE
  With the advent of new oral anticoagulants that do not require regular laboratory control but are significantly more expensive, there has been renewed interest in the quality of the classic agents and the monitoring of patients taking them. We set out to analyze time in therapeutic range of patients under oral anticoagulation monitored in our health unit, to determine whether primary care monitoring is comparable to that in anticoagulation clinics. At the same time, we aimed to ascertain whether there was any association between the dosing method (unit protocol vs. computer-assisted) and the time in therapeutic range achieved.Methods We analyzed all INR values determined in our health unit during the first six months of 2012, using Excel 2007 and SPSS version 17.0, and applying the Student's t test for a level of significance of 0.05.
  
  
  RESULTS
  All INR assessments during the first six months of 2012 were recorded, a total of 320 tests; mean patient age was 69.9±11.25 years, 63% male. Dose adjustments were made according to the unit protocol in 77% of cases. Atrial fibrillation was the most prevalent indication. Most values (65.3%) were within the target therapeutic range; 24.1% were subtherapeutic and 10.6% supratherapeutic. Computer-assisted dosing achieved better control than the protocol (72.5% vs. 62.9%), without statistical significance.
  
  
  CONCLUSIONS
  Primary care monitoring of oral anticoagulation appears to be comparable to that in anticoagulation clinics, while affording better access and cost reductions.
authors.affiliation: Unidade de Saúde Familiar Santigo, Leiria, Portugal. Electronic address: pagnelo@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Agnelo
authors.affiliation: Unidade de Saúde Familiar Santigo, Leiria, Portugal.
authors.forename: Denise
authors.initials: D
authors.lastname: Alexandra
authors.affiliation: Unidade de Saúde Familiar Santigo, Leiria, Portugal.
authors.forename: Sara
authors.initials: S
authors.lastname: Matias
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D055815:Young Adult
chemical_list: D000925:Anticoagulants
keywords: Anticoagulantes; Anticoagulants; Cuidados de saúde primários; International normalized ratio; Primary health care; Índice internacional normalizado