Summary
Oral anticoagulation has proven to be an effective and useful therapy for over 50 years for patients at risk for thromboembolism, but recent evidence suggests that many patients are not only poorly managed, but therapy is withheld from a significant number of individuals because of the fear of complications and the labor intensiveness of treatment.
Over the last decade several developments have occurred that may increase and improve the use of oral anticoagulation by effectively lowering the risk/benefit profile. Among these have been the standardization of the prothrombin time using the International Normalized Ratio leading to more appropriate and standardized therapy, and a number of consensus conferences in the United States and throughout the world focusing on indications for anticoagulation. Less has occurred in a coordinated fashion to substantially improve the management of oral anticoagulation until very recently. There is now accumulating evidence showing that a coordinated and focused approach to the management of therapy by specialized programs significantly improves clinical outcomes by improving therapeutic control, lessening the frequency of hemorrhage or thrombosis and decreasing the use of medical resources leading to more cost-effective therapy. Furthermore, with the development of new technologies for the measurement of prothrombin times (capillary whole blood PTs or point-of-care testing) allows for novel models of management including patient self-testing and patient self-management. These latter concepts are beginning to be popularized in several regions, especially Germany, Canada and the United States.
The focus of the presentation will be to comment on the barriers to more effective and widespread use of anticoagulation and to summarize advances in the management of therapy including the concept of anticoagulation management services, patient self-testing and patient self-management.
Keywords
Anticoagulation - monitoring - warfarin - anticoagulation clinics
