Semin Thromb Hemost 2009; 35(6): 568-573
DOI: 10.1055/s-0029-1240017
© Thieme Medical Publishers

Different Models for Oral Anticoagulation Management May Be Applied Provided That Minimal Assistance Criteria Are Fulfilled: An Italian Experience

Domenico Prisco1 , 2 , Emilia Antonucci1 , Elisa Grifoni1 , Giampiero Mazzaglia3 , Tommaso Bellandi4 , Riccardo Tartaglia4 , Daniela Poli2
  • 1Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
  • 2Department of Heart and Vessels, Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
  • 3Regional Agency for Healthcare Services, Regione Toscana, Florence, Italy
  • 4Centre for Clinical Risk Management and Patient Safety, Regione Toscana, Florence, Italy
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Publikationsdatum:
28. September 2009 (online)

ABSTRACT

The efficacy of adjusted-dose oral anticoagulant therapy (OAT) in the prevention of thrombotic complications in various clinical conditions is well documented. Management of OAT requires a trained physician, an organized system of follow-up, reliable international normalized ratio monitoring, and good patient communication and education. Drug interactions with coumarins are a major cause of excessive anticoagulation and hence could be an important determinant of bleeding in patients on OAT.

An analysis conducted in Toscana in 2005 found 31,221 patients persistently on OAT. During the same period, potential drug-drug interactions were detected in 11,778 of these patients (37.7%). Thus, the regional government enacted a specific law for the organization of OAT management to give all patients a minimal standard of quality of OAT. A specific educational campaign was promoted with the slogan “Written is better.” Three possible models to follow individual patients were identified in relation to available resources and geographic characteristics of the living area: Anticoagulation Clinic (AC), General Practitioner (GP), or combined AC and GP management.

This experience, although obtained in a limited geographic area, could help improve the efficacy and safety of OAT management.

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Domenico PriscoM.D. 

Centro Trombosi, Azienda Ospedaliero-Universitaria Careggi, V.le Morgagni

85 – 50134 Firenze

eMail: priscod@aou-careggi.toscana.it