Spotlight on Evidence Synthesis Program
Safe and Effective Anticoagulation in the Outpatient Setting
Hanna Bloomfield, M.D. MPH
Brent Taylor, Ph.D.
Seminar date: 9/27/2010
Long term anticoagulation with Vitamin K antagonists (e.g., warfarin) has been shown to reduce major thromboembolic complications in patients with many common chronic conditions, including atrial fibrillation, history of deep vein thrombosis and pulmonary embolism, and mechanical heart valves. However, Vitamin K antagonists have a very narrow therapeutic window requiring frequent laboratory monitoring to ensure that patients are neither excessively anti-coagulated, which increases the risk for bleeding, or under anti-coagulated, which increases the risk for thromboembolism. Laboratory monitoring consists of measuring the blood’s tendency to clot with a test known as the International Normalized Ratio (INR), usually performed every 4-6 weeks. Dosage adjustments are then based on these results.
The primary objectives of this systematic review were to: 1. Determine whether specialized anticoagulation clinics (ACC) are more effective and safer than care in non-specialized clinics (e.g., primary care clinics, physician offices) for management of long- term anticoagulation in adults; 2. Determine whether Patient Self Testing (PST), either alone or in combination with Patient Self Management (PSM), is more effective and safer than standard care; and 3. Identify the risk factors for serious bleeding in patients on chronic anticoagulant therapy.
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