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:
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)?
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?
What are the risk factors for serious bleeding in patients on chronic anticoagulant therapy?