Anticoagulation Management as a Risk Factor for Adverse Events: Grounds for Improvement.
Oral anticoagulation therapy has a high risk/benefit profile because of its narrow therapeutic index and the influence of concomitant patient characteristics. The manner in which oral anticoagulation is managed is seldom mentioned as a risk factor for adverse events, but recent studies identify it as such. There are two general models of anticoagulation management, characterized as routine medical care and coordinated care. The literature suggests a rate of major hemorrhage of approximately 10% under the former model, compared with approximately 3.5% under the latter model. Similar, if not greater, differences, are seen for the rate of thrombotic events ( approximately 12% vs. 3.5%). Because of fewer adverse events, coordinated care results in cost savings due to reduced hospitalizations and emergency room visits. If the full benefit of anticoagulation is to be gained, there is a strong rationale for the development and promotion of anticoagulation management services.
Ansell
JE
Department of Medicine, Boston University Medical Center, Boston, Massachusetts.