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[Is optimal anticoagulation possible in ambulatory practice? Report on a retrospective 5-year study of a cardiology
Insights
This study found that optimal anticoagulation therapy is achievable with minimal complications in most patients. Phenprocoumon demonstrated high rates of successful long-term anticoagulation, suggesting effective management is possible.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Context:
- Retrospective analysis of 332 patients over 5 years (1982-1978).
- Focus on achieving optimal anticoagulation with minimal complications.
- Utilized Quick test (18-29%), INR (4.0-2.75), Geigy thromboplastin, and capillary blood method.
Purpose:
- To evaluate the feasibility of achieving optimum anticoagulation with minimum complications.
- To assess the effectiveness of different anticoagulants, particularly phenprocoumon.
- To determine if optimal anticoagulation can be identified early in therapy.
Summary:
- 75% of phenprocoumon patients and 72% of all anticoagulated patients achieved optimal Quick test ranges.
- 77% of phenprocoumon patients maintained optimal anticoagulation for over 3 years.
- Optimal anticoagulation feasibility is recognizable after 6 months of therapy.
Impact:
- Demonstrates that effective anticoagulation management is achievable in a clinical practice setting.
- Highlights phenprocoumon as a potentially effective agent for long-term anticoagulation.
- Suggests a 6-month treatment window for assessing the success of anticoagulation therapy and making treatment decisions.
Abstract:
In a 5-year retrospective study (1982-1978) in a well defined population of 332 patients (representing greater than or equal to 2140 anticoagulation years) from a heart specialist's practice, the question was studied whether optimum anticoagulation (Quick test between 18-29%, INR 4.0-2.75, Geigy thromboplastin, capillary blood method) with minimum complications could be achieved. In the qualitative study it was found that 75% of Quick determinations were in the optimum range for phenprocoumon, 71.6% for clorindion, 62% for acenocoumarol and 72% for all anticoagulants. 77% of phenprocoumon patients were optimally anticoagulated for more than 3 years. With phenprocoumon there was no difference in intensity of anticoagulation between the oldest and youngest patient groups, as all mean Quick values ranged over 20% (means Q% 1982-1978 = 25, INR = 3.0). It was also shown that after 6 months' anticoagulant therapy it is clearly recognizable whether optimum anticoagulation is feasible or not: at that moment the criteria for halting or continuing anticoagulant therapy can and should be reviewed.