a-t 2015; 46: 23

Quality of oral anticoagulation with phenprocoumon (MARCUMAR, generics) in Germany: It is repeatedly being argued that outside of studies it is not possible to adjust the INR to the extent achieved with warfarin (COUMADIN) in the approval studies for the new oral anticoagulants (a-t 2011; 42: 74-7; 2012; 43: 2-4 and 11-12; 2013; 44: 3-4 and 13). A current study analysed the quality of oral anticoagulation with coumarines in 2,011 patients treated in usual care settings in Germany during the period from 2011 to 2013. Nearly 30,000 INR values were analysed. About 98% of the patients were taking phenprocoumon (MARCUMAR, generics). For patients with atrial fibrillation (73%) median time of INR values within the therapeutic range was 68% (1). This rate is therefore higher than that achieved with warfarin in the studies on new oral anticoagulants (58% to 66%). This rate is also higher than that established in a systematic review of retrospective observational studies (56%) and randomised studies (65%) in which patients were predominantly treated with warfarin (2). In another 760 patients included in this current study, who received treatment in specialised centres using telemedical infrastructure, INR values were within the therapeutic range 75% of the time. Patients with self-management of anticoagulation achieved INR values within the target range more than 80% of the time both when receiving regular as well as specialised care. The authors believe that the main reason for these comparatively good INR adjustments is the use of the long-acting phenprocoumon instead of a shorter-acting coumarin such as warfarin (cp. a-t 2015; 46: 20-1), and they point out that with phenprocoumon it is possible to achieve stable and good adjustment of anticoagulation even in regular medical care conditions (1).

1PROCHASKA, J.H. et al.: BMC Medicine 2015; 13: 14; doi: 10.1186/s12916-015-0268-9
2WAN, Y. et al.: Circ. Cardiovasc. Qual. Outcomes 2008; 1: 84-91

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