Comparison of the Quality of Oral Anticoagulant Therapy Through Patient Self-management and Management by Specialized Anticoagulation Clinics in the Netherlands

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Abstract
ORAL ANTICOAGULANT therapy (OAT) with coumarin drugs is of vital importance in the treatment and prophylaxis of thromboembolic disease. The efficiency and relative safety of oral anticoagulants have been proven in clinical studies that have also led to define different therapeutic ranges for OAT for different indications. In many cases a minimal international normalized ratio (INR) of 2.0 to 2.5 is sufficient for efficient anticoagulation,1-3 but indications with a high thromboembolic potential require more intensive anticoagulation. An increase in INR values is, however, associated with an increased risk of bleeding.4-7 This implies that strictly maintaining the INR within the therapeutic range is required to ensure treatment efficacy with the lowest possible risks of thromboembolic and bleeding complications.