What about quality in anticoagulation?
During the 53. annual meeting of the German society for thrombosis and hemostasis research (GTH) in Vienna, Austria (Feb., 4th - 7th, 2009), the occurrence of thrombotic events and the respective therapies were discussed in depth. A hot topic were bridging strategies with anticoagulants. But also, the lack of quality in the anticoagulation therapy was mentioned. However, no hints were given in terms of “How do I improve the quality of treatment to improve the safety of patients on anticoagulated patients?” In Germany approx. 800’000 people are treated with anticoagulants. 160'000 of them perform patient self-management (PSM). The number of anticoagulated patients will significantly increase in upcoming years – due to the aging population. A high proportion of them are patients with atrial fibrillation. It will take some time until novel factor Xa inhibitors will be approved and available. In other words: half a million patients have their INR checked every 4 weeks on average. And not only in Germany, but also world-wide. In the US, every year more than 30’000 patients are admitted to the emergency room due to severe bleedings after intake of oral anticoagulants (Wysowsky, DK, 2007).
Prof. D. Prisco, MD, Florence, strongly advocated for an improved safety for anticoagulated patients during the 4th International Patient-Physician Conference of ISMAAP Oct 31st 2008 in Sitges/Spain. Risk factors should be assessed early on. Risk factors consist of e.g. age > 75 years, kidney- and liver diseases, cancer, alcohol abuse, increased risk of falling, previous bleedings, prior stroke and highly variable INR-values.
According to Prof. Prisco, the treatment with anticoagulants can be improved by a closer interaction between physician and patient and by patient self management.
Christian Schaefer, ISMAAP, Geneva (April 26th, 2009)