Definition of indicators of the appropriateness of oral anticoagulant prescriptions in hospitalized adults: Literature review and consensus (PACHA study)

Arch Cardiovasc Dis. 2018 Mar;111(3):155-171. doi: 10.1016/j.acvd.2017.05.005. Epub 2017 Sep 21.


Background: Indicators of the appropriateness of oral anticoagulant prescriptions are lacking, despite the major contribution they could make to improve quality of care.

Aim: To identify and select such indicators according to their utility and operational implementation.

Methods: A literature review was conducted to identify indicators of the appropriateness of oral anticoagulant prescriptions according to the guidelines of health authorities and European learned societies. A first list of indicators was identified from guidelines related to general or targeted clinical situations. A two-round Delphi consensus process, completed by a synthesis meeting, was then set up to ask European experts to rate the utility and operational implementation of the indicators on a qualitative binary scale. An indicator was selected if ≥80% of the experts judged it both useful and implementable (strong consensus).

Results: We selected 32 references, from which 84 indicators were identified. Nineteen indicators were short-listed for submission to expert judgment. Twenty-two experts participated in the Delphi process. Sixteen indicators obtained strong consensus for selection; three indicators did not achieve consensus. Two-thirds of the selected indicators focused on the appropriateness of oral anticoagulant prescriptions in general or in patients with atrial fibrillation; the other third focused on the appropriateness of prescriptions in patients with a prosthetic heart valve, venous thromboembolism or trauma.

Conclusion: This work addresses the current lack of indicators of the appropriateness of oral anticoagulant prescriptions. The selected indicators will be implemented from the hospital information system to assess their metrological properties to detect inappropriate prescriptions.

Keywords: Anticoagulants; Appropriateness; Consensus; Indicateur de qualité; Pertinence; Quality indicators; Review; Revue de littérature.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Administration, Oral
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Consensus
  • Delphi Technique
  • Drug Prescriptions
  • Drug Utilization Review
  • Guideline Adherence / standards
  • Hospitalization*
  • Humans
  • Inappropriate Prescribing / prevention & control*
  • Practice Guidelines as Topic / standards
  • Practice Patterns, Physicians' / standards*
  • Quality Improvement / standards
  • Quality Indicators, Health Care / standards


  • Anticoagulants