Improved therapeutic safety of oral anticoagulant therapy in Germany: The Saarland model

In contrast to other European countries, in Germany more than 90% of oral a nticoagulated patients are controlled by general practitioners. The Interna tional Normalized Ratio (INR) system in laboratory control is not in widesp read use, often leading to misinterpretations of prothrombin time (PT) meas urements. To improve the management of anticoagulated patients, a model was developed, consisting of different questionnaires and on the base of the I NR system. Since 1993, 60 patients in our Department's outpatient anticoagu lant clinic and since 1996 16 patients in the office of a general practitio ner were followed for 146.32 patient years. There were no thromboembolic ev ents and no major bleedings during follow-up. A total of 126 minor bleeding s occurred in 30 patients. There were no significant differences in INR val ues and stable phases between the two centers; however, significantly short er stable phases in patients with bleeding episodes were noted. Thus, this model seems to be useful also in general practitioners' hands.