Delivery of optimized anticoagulant therapy: consensus statement from the Anticoagulation Forum.
OBJECTIVE
To provide recommendations, policies, and procedures pertaining to the provision of optimized anticoagulation therapy designed to achieve desired clinical endpoints while minimizing the risk of anticoagulant-related adverse outcomes (principally bleeding and thrombosis).


METHODS
Due to this document's scope, the medical literature was searched using a variety of strategies. When possible, recommendations are supported by available evidence; however, because this paper deals with processes and systems of care, high-quality evidence (eg, controlled trials) is unavailable. In these cases, recommendations represent the consensus opinion of all authors who constitute the Board of Directors of The Anticoagulation Forum, an organization dedicated to optimizing anticoagulation care. The Board is composed of physicians, pharmacists, and nurses with demonstrated expertise and significant collective experience in the management of patients receiving anticoagulation therapy.


RESULTS
Recommendations for delivering optimized anticoagulation therapy were developed collaboratively by the authors and are summarized in 9 key areas: (I) Qualifications of Personnel, (II) Supervision, (III) Care Management and Coordination, (IV) Documentation, (V) Patient Education, (VI) Patient Selection and Assessment, (VII) Laboratory Monitoring, (VIII) Initiation and Stabilization of Warfarin Therapy, and (IX) Maintenance of Therapy. Recommendations are intended to inform the development of care systems containing elements with demonstrated benefit in improvement of anticoagulation therapy outcomes. Recommendations for delivering optimized anticoagulation therapy are intended to apply to all clinicians involved in the care of outpatients receiving anticoagulation therapy, regardless of the structure and setting in which that care is delivered.


CONCLUSIONS
Anticoagulation therapy, although potentially life-saving, has inherent risks. Whether a patient is managed in a solo practice or a specialized anticoagulation management service, a systematic approach to the key elements outlined herein will reduce the likelihood of adverse events. The need for continued research to validate optimal practices for managing anticoagulation therapy is acknowledged.
Garcia
David A
DA
University of New Mexico School of Medicine, Albuquerque, NM, USA. DAVGarcia@salud.unm.edu
Witt
Daniel M
DM
Hylek
Elaine
E
Wittkowsky
Ann K
AK
Nutescu
Edith A
EA
Jacobson
Alan
A
Moll
Stephan
S
Merli
Geno J
GJ
Crowther
Mark
M
Earl
Laura
L
Becker
Richard C
RC
Oertel
Lynn
L
Jaffer
Amir
A
Ansell
Jack E
JE
D000925:Anticoagulants / Q000627:therapeutic use*; D006282:Health Personnel / Q000193:education / Q000592:standards; D006801:Humans; D054539:Medication Therapy Management / Q000592:standards*; D018579:Patient Selection; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin