Abstract
Anticoagulation Clinics (ACs) are services specialized in management of patients on anticoagulant treatment. At present, ACs manage patients chiefly on antivitamin K antagonists (AVKs), but patient population has already changed in the last few years, because of an increase of treatments with other anticoagulant drugs, which require different management systems. The strong increase in the number of patients at AC, mainly on long-term treatment, has determined the development of web management, through telemedicine systems, improving the quality of life and maintaining the same clinical quality levels. New oral anticoagulants (NOAs) have shown to be as effective as AVK antagonists in stroke prevention in atrial fibrillation and for treatment of venous thromboembolism in addition to VTE prophylaxis in orthopaedic surgery, when administered at a fixed dose, but patient adherence and compliance are crucial for good quality treatment. At present, lacking data from the real world, an oversimplification of treatment with NOAs could cause unjustified risks for patients and also a possible future underuse of good drugs. For these reasons the vigilance must be high and ACs can have a crucial role in defining which is the best management for NOA patients and how to do it, as it happened for AVKs.
Highlights
Anticoagulation Clinics (ACs) are services specialized in management of patients on anticoagulant treatment
ACs manage patients on antivitamin K antagonists (AVKs), but patient population has already changed in the last few years, because of an increase of treatments with other anticoagulant drugs, such as low molecular weight heparin (LMWH) or pentasaccharides, which require different management systems
Even if New oral anticoagulants (NOAs) proved to be effective and safe when administered at a fixed dose, laboratory tests could be useful in clinical practice for measuring the anticoagulant effect in specific conditions such as: bleeding and thrombotic complications, surgery or invasive procedures, renal impairment, liver disease, and potential overdosages [24]
Summary
Anticoagulation Clinics (ACs) are services specialized in management of patients on anticoagulant treatment. AVKs, that until few months ago were the only oral available anticoagulant agents, are life-saving therapies that can effectively prevent cardioembolic strokes related to atrial fibrillation and heart valve replacements and treat venous thromboembolism. Because of their characteristics AVKs need a strict laboratory and clinical control to ensure efficacy and safety [1]. Effectiveness and safety of AVKs increase when a good control of anticoagulation level is guaranteed For this reason, a correct use of AVK requires a careful clinical and laboratory monitoring, as well as specific competences for managing complications and/or emergencies [1]
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