Use of New Oral Anticoagulants in Primary Care Practices
DOI: 10.3238/zfa.2016.0028-0032german translation / full article
Background: With the introduction of new oral anticoagulants (NOAC) in 2008 alternatives to the classical vitamin K antagonists (VKA) for the prevention of thromboembolic disorders are available. Based on prescription data the present study examined handling of family practitioners with the new group of substances.
Methods: In 12 primary care practices we retrospectively analysed 375 patient records whether a NOAC was prescribed within the last 4 years. We documented the active ingredient used and the daily dose where patients received directly a prescription of NOACs. When changing the setting of anticoagulation quality was determined on a VKA. In all patients we looked at doctors who had carried out the initial setting or change to a NOAC.
Results: 353 patients were included in the study. Most patients were directly set on a NOAC. The initial setting has been performed frequently in an inpatient setting. At 14 %, a change from a VKA to a NOAC was performed. Before changing 73 % were in an unstable setting. The change of anticoagulation was initiated mainly by family practitioners. In almost all cases there was at least one argument (92 %) against the use of a NOAC.
Conclusions: NOACs were often used directly or when problems with VKA existed. However, we found reasons against the use of this drug class in many patients. Consequently, all options, such as the optimization of VKA therapy should be discussed before the start of therapy or change.