Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

Safe and Effective Anticoagulation in the Outpatient Setting

Click for list of published reports
Click for topic nomination form
Click for list of reports in progress

Subscribe to the
ESP Report RSS feed RSS feed icon
Safe and Effective Anticoagulation in the Outpatient Setting

Investigators: Hanna E. Bloomfield, MD, MPH; Brent C. Taylor, PhD, MPH; Ange Krause, MD; and Preetham Reddy, MD.

VA Evidence-based Synthesis Program (ESP) Center Center for Chronic Disease Outcomes Research Minneapolis VA Medical Center

Washington (DC): Department of Veterans Affairs; February 2011.

Download PDF: Complete Report, Executive Summary, Report, Appendices

Summary / Overview

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 (atrial fibrillation; history of deep vein thrombosis and pulmonary embolism; 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.

In this systematic literature review, the following key questions were addressed:

  1. For management of long-term outpatient anticoagulation in adults, are specialized anticoagulation clinics (ACC) more effective and safer than care in non-specialized clinics (e.g., primary care clinics, physician offices)?
    1a. Which components of a specialized anticoagulation clinic are associated with effectiveness/safety?
  2. Is Patient Self Testing (PST), either alone or in combination with Patient Self Management (PSM), more effective and safer than standard care delivered in either ACCs or non-specialized clinics?
  3. What are the risk factors for serious bleeding in patients on chronic anticoagulant therapy?

See also

A Synthesis of the Evidence: Safe and Effective Anticoagulation in the Outpatient Setting (VA HSR&D Management e-Brief)

Cyber Seminar on Safe and Effective Anticoagulation in the Outpatient Setting

Bloomfield H, Krause A, Greer N, Taylor BC, MacDonald R, Rutks I, Reddy P, Wilt TJ. Meta-analysis: Effect of Patient Self-testing and Self-management of Long-Term Anticoagulation on Major Clinical Outcomes. Ann Intern Med. 2011 Apr 5;154(97):472-482.




>