title: Direct new oral anticoagulants: follow-up, guidelines and bleeding complications in general practice-a survey of Swiss general internal medicine practitioners.
abstract: BACKGROUND
  The present study investigated how much Swiss general internal medicine practitioners (GPs) know about new direct oral anticoagulants (NOACs), particularly the relevant guidelines, follow-up tests, dosing adjustments, indications and complications. We conducted a paper-based survey of GPs, performed in Bern, Switzerland. Our questionnaire assessed the physicians' preference for NOACs rather than vitamin K antagonists (VKA), prevalence and choice of NOAC, clinical follow-up including follow-up blood testing, and bleeding complications.
  
  
  RESULTS
  53 GPs participated in our pilot investigation. They treated 32.7% ± 19 of their patients requiring oral anticoagulation with NOACs. New patients who had started oral anticoagulation received NOACs from 49 GPs (92.5%) but most GPs would not switch patients from existing VKA therapy to NOACs. Clinical controls are scheduled by a majority of GPs (67.9%) at least every 3 months; creatinine and haemoglobin are monitored by most GPs (51 (96.2%) and 39 (73.6%), respectively). In the preceding 2 years, GPs had seen 1.9 ± 2.87 bleeding complications in patients with NOACs. 0.5 ± 0.95 (range 0-5) of these required hospital treatment.
  
  
  CONCLUSIONS
  NOACs are broadly accepted by investigated Swiss GPs as the first choice for patients newly requiring oral anticoagulation. This was in preference to VKAs and especially if recommended by a haematologist or cardiologist. As, in our population, only about two-thirds of GPs adhere to recommendations on clinical and blood test follow-ups, further efforts to implement follow-up guidelines seem necessary. Further research in a large representative GP population is recommended; this should compare NOACs and VKAs. Bleeding complications were rare in our population and could mostly be handled without hospital admission.
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Sauter
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Carlo
authors.initials: C
authors.lastname: Melis
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Wolf E
authors.initials: WE
authors.lastname: Hautz
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Meret E
authors.initials: ME
authors.lastname: Ricklin
authors.affiliation: Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.
authors.forename: Aristomenis K
authors.initials: AK
authors.lastname: Exadaktylos
keywords: Apixaban; Bleeding event; Dabigatran; Everyday general practice; Real-life; Rivaroxaban