Semin Vasc Med 2003; 03(3): 261-270
DOI: 10.1055/s-2003-44462
Copyright © 2003 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Optimizing the Efficacy and Safety of Oral Anticoagulant Therapy: High-Quality Dose Management, Anticoagulation Clinics, and Patient Self-Management

Jack E. Ansell
  • Department of Medicine, Boston University Medical Center, Boston, MA
Further Information

Publication History

Publication Date:
21 November 2003 (online)


Despite its widespread use, oral anticoagulation therapy suffers from a number of problems that lead to underuse and inadequate treatment. Problems include its narrow therapeutic index, the influence of many concomitant conditions or comorbidities, and the need for high-quality dose management. Poor management of oral anticoagulation is a prime factor influencing the occurrence of adverse events. As a result of these problems, special programs or anticoagulation management services (AMSs) have developed to manage oral anticoagulation. Such programs have demonstrated a significant improvement in outcomes compared with traditional or usual care (UC) by individual physicians. With the introduction of point-of-care prothrombin time monitors, the potential for patient self-testing and self-management has developed. Studies show the possibility of even further improvement in outcomes compared with UC, although the differences from those achieved with an AMS are less impressive.


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