A long-term follow-up quality evaluation of patients under oral anticoagulant therapy

Objectives: the aim of this study was to estimate the population under Vitamin-K antagonists (VKA) in the region of Limousin (France), and to assess the treatment quality and the level of knowledge of the patients. Methods: a transversal study permitted to identify all the patients under VKA under the French general health care coverage. During 6 months, a cohort of 370 patients had been followed. Major data measured were: the number of INK the duration within the therapeutic range, the duration in the hazardous zone (INR > 4.5), the level of patients' education and the knowledge on the treatment's indication by biologists. Data were collected through the French general health care database as well as questionnaires sent to general practitioners, biologists and patients. Results: one percent of the entire population was under VKA. The mean number of INR performed during 6 months was 6.6, and 36.5% of patients had less than one biological control monthly. The mean duration passed within the therapeutic range was at 54%. The hazardous zone was reached by 22% of the patients. The level of education of the patients was poor in one half of the patients. The indication of the treatment was known in 6% of patients' biologists. Conclusion: these results reflect the limits of application of recommendations. Facing to this evidence, it is necessary to optimize the management and follow-up of these treatments, especially through the development of public health charters with biologists, education with patients, or even anticoagulant clinics.