Comparison of control and stability of oral anticoagulant therapy using acenocoumarol versus phenprocoumon

Stephan D. Fihn; Alain A. P. Gadisseur; Edwin Pasterkamp; Felix J. M. van der Meer; W. G. Mimi Breukink-Engbers; Lya M. Geven-Boere; Erik van Meegen; Hanneke de Vries-Goldschmeding; Irma Antheunissen-Anneveld; Annelies R. van’t Hoff; Derk Harderman; Margriet Smink; Frits R. Rosendaal

doi:10.1160/TH02-10-0179

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2003; 90(02): 260-266
DOI: 10.1160/TH02-10-0179

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Comparison of control and stability of oral anticoagulant therapy using acenocoumarol versus phenprocoumon

Stephan D. Fihn

¹Northwest Health Services Research Center of Excellence, Veteran Affairs Puget Sound Health Care System

²Department of Medicine of the University of Washington, Seattle, Washington, USA

,

Alain A. P. Gadisseur

⁴Thrombosis Center of the Leiden University Medical Center

,

Edwin Pasterkamp

³Department of Clinical Epidemiology and Hemostasis and

,

Felix J. M. van der Meer

⁴Thrombosis Center of the Leiden University Medical Center

,

W. G. Mimi Breukink-Engbers

⁵Oostgelderland Anticoagulation Clinic, Lichtenvoorde

,

Lya M. Geven-Boere

⁶Leeuwarden Anticoagulation Clinic

,

Erik van Meegen

⁷Anticoagulation Clinic of the Hague

,

Hanneke de Vries-Goldschmeding

⁸Thrombosis Center of the Utrecht Division of the Dutch Red Cross

,

Irma Antheunissen-Anneveld

⁹Schiedam Anticoagulation Clinic

,

Annelies R. van’t Hoff

¹Northwest Health Services Research Center of Excellence, Veteran Affairs Puget Sound Health Care System

,

Derk Harderman

¹Northwest Health Services Research Center of Excellence, Veteran Affairs Puget Sound Health Care System

,

Margriet Smink

¹Northwest Health Services Research Center of Excellence, Veteran Affairs Puget Sound Health Care System

,

Frits R. Rosendaal

³Department of Clinical Epidemiology and Hemostasis and

⁴Thrombosis Center of the Leiden University Medical Center

› Author Affiliations

Abstract

Summary

Variability in the control of oral anticoagulant therapy has been associated with a heightened risk of complications. We compared control of anticoagulation between two commonly used coumarins, phenprocoumon and acenocoumarol, and among anticoagulation clinics.

All qualifying patients were managed at six regional anticoagulation clinics in the Netherlands.

This retrospective cohort study compiled data during a three-year period from a computerised dosing and management system. Anticoagulation control was expressed as the percent of time within the therapeutic range and stability expressed as the time-weighted variance in the international normalised ratio (INR). Data were available for 22,178 patients of whom 72% were treated with acenocoumarol. INRs of patients who received phenprocoumon were within the therapeutic range 50% of the time compared with 43% for acenocoumarol (OR 1.32,95% CI 1.24-1.41). Moreover, patients on phenprocoumon required 15% fewer monitoring visits and had more stable INR values. These observations were consistent for all six clinics. There were also sizable differences between the clinics with respect to control and stability of anticoagulation that were stable from year-to-year and were unrelated to the drug used.

With its longer half-life of three to five days, phenprocoumon produces more stable anticoagulation than acenocoumarol and should generally be the drug of choice when these are the available choices. The differences observed among clinics suggest that certain clinics employ policies and practices resulting in better control of anticoagulation.

Keywords

Anticoagulation - international normalised ratio - phenprocoumon - acenocoumarol

Full Text

References

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