Direct new oral anticoagulants: follow-up, guidelines and bleeding complications in general practice-a survey of Swiss general internal medicine practitioners

作者：Sauter Thomas C^*; Melis Carlo; Hautz Wolf E; Ricklin Meret E; Exadaktylos Aristomenis K

来源：SpringerPlus, 2016, 5(1): 2030.

DOI：10.1186/s40064-016-3722-z

• Apixaban
• Bleeding event
• Dabigatran
• Everyday general practice
• Real-life
• Rivaroxaban

Background: The present study investigated how much Swiss general internal medicine practitioners (GPs) know about new direct oral anticoagulants (NOACs), particularly the relevant guidelines, follow-up tests, dosing adjustments, indications and complications. We conducted a paper-based survey of GPs, performed in Bern, Switzerland. Our questionnaire assessed the physicians' preference for NOACs rather than vitamin K antagonists (VKA), prevalence and choice of NOAC, clinical follow-up including follow-up blood testing, and bleeding complications.
Results: 53 GPs participated in our pilot investigation. They treated 32.7% +/- 19 of their patients requiring oral anticoagulation with NOACs. New patients who had started oral anticoagulation received NOACs from 49 GPs (92.5%) but most GPs would not switch patients from existing VKA therapy to NOACs. Clinical controls are scheduled by a majority of GPs (67.9%) at least every 3 months; creatinine and haemoglobin are monitored by most GPs (51 (96.2%) and 39 (73.6%), respectively). In the preceding 2 years, GPs had seen 1.9 +/- 2.87 bleeding complications in patients with NOACs. 0.5 +/- 0.95 (range 0-5) of these required hospital treatment.
Conclusion: NOACs are broadly accepted by investigated Swiss GPs as the first choice for patients newly requiring oral anticoagulation. This was in preference to VKAs and especially if recommended by a haematologist or cardiologist. As, in our population, only about two-thirds of GPs adhere to recommendations on clinical and blood test followups, further efforts to implement follow-up guidelines seem necessary. Further research in a large representative GP population is recommended; this should compare NOACs and VKAs. Bleeding complications were rare in our population and could mostly be handled without hospital admission.

• 出版日期2016-11-29