Consensus Guidelines for Coordinated Outpatient Oral Anticoagulation Therapy Management

Abstract

Systematic outpatient anticoagulation services are systems of care designed to coordinate and optimize the delivery of anticoagulation therapy by (1) evaluating patient-specific risks and benefits to determine the appropriateness of therapy; (2) facilitating the management of anticoagulation dosages and prescription pick up or delivery; (3) providing ongoing education of the patient and other caregivers about warfarin and the importance of self-care behavior leading to optimal outcomes; (4) providing continuous systematic monitoring of patients, international normalized ratio results, diet, concomitant drug therapy, and disease states; and (5) communicating with other healthcare practitioners involved in the care of the patient. To create a reproducible framework for the provision of these services, guidelines for structure, process, and outcomes of coordinated outpatient anticoagulation management services were developed. Guidelines for organization and management include (1) qualifications for personnel, (2) supervision, (3) care management and coordination, (4) communication and documentation, and (5) laboratory monitoring. Guidelines for the process of patient care include (6) patient selection and assessment, (7) initiation of therapy, (8) maintenance and management of therapy, (9) patient education, and (10) management and triage of therapy-related and unrelated problems. Guidelines for the evaluation of patient outcomes include (11) organizational components and (12) patient outcomes. The impact of these 12 guidelines on patient care and reimbursement procurement will depend on their implementation and the perceived value of their use.

Patients’ Understanding of Anticoagulant Therapy in a Multiethnic Population

“…Adherence to medical advice and routine monitoring of the international normalized ratio (INR) are therefore important, and in England the service is usually provided by specialized anticoagulation clinics. 2,3 There is good evidence [4][5][6][7][8][9] that adherence to medical treatment is enhanced by knowledge and understanding of the drug, its benefits and its side-effects. Other influences are the views of family and friends, societal pressures and cultural or ethnic background.…”

The Potential Inhibitory Effect of Revaprazan, an Acid Pump Antagonist, on Anticoagulation with Warfarin

“…Even though it may be cumbersome to check a patient's INR regularly in order to properly adjust the dose, warfarin is certainly a lifesaving medicine (Ansell et al 1997). While the appropriate individual warfarin dose is affected by weight, age, and sex as well as the genetic polymorphism like cytochrome (CYC) P450 isoenzyme and vitamin K epoxide reductase complex subunit 1 (Wadelius et al 2005; Aquilante et al 2006), the major factors that induce unexpected change of INR are usually other coadministered medications, food, alcohol, and dietary supplements.…”

“…A close monitoring of the clotting level is required in order to maintain the balance between bleeding and thrombosis. Therefore, when other drugs are co-prescribed with warfarin, they should be checked to see whether or not they affect the anti-coagulative effect of warfarin (Ansell et al 1997).…”

A Description of a Multistaged Professional Development Course for Practising Pharmacists in Anticoagulation Management

“…8 To enhance the provision of anticoagulation care, the Forum developed consensus statements outlining suggested policies and procedures. 9,10 In designing our AMS, these were considered and implemented in our daily operations. Second, the Anticoagulation Forum offers a certification examination.…”