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Therapeutic control of oral anticoagulant treatment in The Netherlands
A M van den Besselaar1, F J van der Meer, C W Gerrits-Drabbe
1Department of Hematology, University Hospital of Leiden, The Netherlands.
Insights
Accurate assessment of anticoagulant therapy control is crucial. The "cross-section-of-the-files" method, using the last prothrombin time, is the most reliable way to measure therapeutic control in anticoagulant clinics.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Effective anticoagulant therapy requires precise monitoring of prothrombin time (PT).
- Assessing therapeutic control in anticoagulant clinics is vital for patient safety and treatment efficacy.
- Existing methods for evaluating PT control have limitations.
Purpose of the Study:
- To compare three different methods for calculating the proportion of time patients spend within the target prothrombin time range.
- To identify the most accurate method for assessing therapeutic control in anticoagulant clinics.
- To evaluate the level of therapeutic control achieved by anticoagulant clinics in the Netherlands.
Main Methods:
- Utilized a database from the Leiden Thrombosis Centre to compare three PT control calculation methods.
- Identified the "cross-section-of-the-files" approach, using the last recorded PT per patient, as the most accurate.
- Applied this method to data from 37 other thrombosis centers in the Netherlands with a target International Normalized Ratio (INR) range of 2.8-4.8.
Main Results:
- The "cross-section-of-the-files" method demonstrated superior accuracy compared to two other methods.
- The Leiden Thrombosis Centre achieved 80% therapeutic control in long-term patients using this method.
- Thirty-one out of 37 Dutch centers achieved at least 70% therapeutic control, with underanticoagulation being more frequent than overanticoagulation.
Conclusions:
- The "cross-section-of-the-files" method is the most accurate for assessing anticoagulant therapy control and should be widely implemented.
- Most anticoagulant clinics in the Netherlands are achieving acceptable levels of therapeutic control.
- Underanticoagulation is a more prevalent issue than overanticoagulation in these centers.
Abstract:
Therapeutic control achieved by an anticoagulant clinic may be assessed by calculation of the proportion of time spent by the patients within the prothrombin time target range aimed for by the clinic. Three calculation methods for such assessment have been described by other investigators. The three methods were compared with the use of the database of one anticoagulant clinic (Leiden Thrombosis Centre). Discrepant levels of control were obtained by these methods because of incorrect assumptions in two of them. The most accurate method is the "cross-section-of-the-files" approach, in which the last-recorded prothrombin time per patient is used. The authors believe it should be implemented in each anticoagulant clinic. With the use of this method, the level of therapeutic control achieved by the Leiden Thrombosis Centre for its patients on long-term treatment amounted to 80%. The same method was applied by 37 other thrombosis centers in the Netherlands using a single target range of 2.8-4.8 International Normalized Ratio for their patients. Thirty-one centers achieved a level of control of at least 70% in their long-term patients. Underanticoagulation was observed more frequently than overanticoagulation.