title: Anticoagulant treatment in German family practices - screening results from a cluster randomized controlled trial.
abstract: BACKGROUND
  Oral anticoagulation (OAC) with coumarins and new anticoagulants are highly effective in preventing thromboembolic complications. However, some studies indicate that over- and under-treatment with anticoagulants are fairly common. The aim of this paper is to assess the appropriateness of treatment in patients with a long-term indication for OAC, and to describe the corresponding characteristics of such patients on the basis of screening results from the cluster randomized PICANT trial.
  
  
  METHODS
  Randomly selected family practices in the federal state of Hesse, Germany, were visited by study team members. Eligible patients were screened using an anonymous patient list that was generated by the general practitioners' software according to predefined instructions. A documentation sheet was filled in for all screened patients. Eligible patients were classified into 3 categories (1: patients with a long-term indication for OAC and taking anticoagulants, 2: patients with a long-term indication for OAC but not taking anticoagulants, 3: patients without a long-term indication for OAC but taking an anticoagulant on a permanent basis). IBM SPSS Statistics 20 was used for descriptive statistical analysis.
  
  
  RESULTS
  We screened 2,036 randomly selected, potentially eligible patients from 52 family practices. 275 patients could not be assigned to one of the 3 categories and were therefore not considered for analysis. The final study sample comprised 1,761 screened patients, 1,641 of whom belonged to category 1, 78 to category 2, and 42 to category 3. INR values were available for 1,504 patients of whom 1,013 presented INR values within their therapeutic ranges. The majority of screened patients had very good compliance, as assessed by the general practitioner. New antithrombotic drugs were prescribed in 6.1% of cases.
  
  
  CONCLUSIONS
  The screening results showed that a high proportion of patients were receiving appropriate anticoagulation therapy. The numbers of patients with a long-term indication for OAC therapy that were not receiving oral anticoagulants, and without a long-term indication that were receiving OAC, were considerably lower than expected. Most patients take coumarins, and the quality of OAC control is reasonably high.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN41847489.
authors.affiliation: Institute of General Practice, Goethe-University Frankfurt, Frankfurt, Germany. ulrich@allgemeinmedizin.uni-frankfurt.de.
authors.forename: Lisa-R
authors.initials: LR
authors.lastname: Ulrich
authors.forename: Karola
authors.initials: K
authors.lastname: Mergenthal
authors.forename: Juliana J
authors.initials: JJ
authors.lastname: Petersen
authors.forename: Ina
authors.initials: I
authors.lastname: Roehl
authors.forename: Sandra
authors.initials: S
authors.lastname: Rauck
authors.forename: Birgit
authors.initials: B
authors.lastname: Kemperdick
authors.forename: Sylvia
authors.initials: S
authors.lastname: Schulz-Rothe
authors.forename: Andrea
authors.initials: A
authors.lastname: Berghold
authors.forename: Andrea
authors.initials: A
authors.lastname: Siebenhofer
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy; D001562:Benzimidazoles / Q000627:therapeutic use; D003374:Coumarins / Q000627:therapeutic use; D000069604:Dabigatran; D005194:Family Practice / Q000592:standards*; D005260:Female; D005858:Germany; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006331:Heart Diseases / Q000188:drug therapy; D006350:Heart Valve Prosthesis; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009025:Morpholines / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D011655:Pulmonary Embolism / Q000517:prevention & control; D011720:Pyrazoles / Q000627:therapeutic use; D011728:Pyridones / Q000627:therapeutic use; D000069552:Rivaroxaban; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013876:Thiophenes / Q000627:therapeutic use; D013923:Thromboembolism / Q000517:prevention & control*; D013927:Thrombosis / Q000188:drug therapy; D054556:Venous Thromboembolism / Q000517:prevention & control; D015091:beta-Alanine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D003374:Coumarins; D009025:Morpholines; D011720:Pyrazoles; D011728:Pyridones; D013876:Thiophenes; D015091:beta-Alanine; C522181:apixaban; D000069552:Rivaroxaban; D000069604:Dabigatran