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

ABSTRACT

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.

KEYWORDS

Oral anticoagulation - warfarin - prothrombin time - International Normalized Ratio - adverse events - point-of-care monitoring

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