The Anticoagulation Clinic

  • Nathan P. Clark
  • Daniel M. Witt


Anticoagulant drug therapy presents significant risks of life-threatening bleeding and treatment failure resulting in thromboembolic complications. Safe and effective anticoagulation relies upon an organized system of care delivery, close collaboration between healthcare teams, effective communication with patients, and anticoagulation management performed by healthcare professionals with specialized training. The anticoagulation management service (AMS) was developed to meet these objectives in efforts to optimize warfarin management. The vitamin K antagonist notorious for its complex pharmacology was the only oral anticoagulant option for more than 50 years, and it took most of that time to sort out how to use it well. The introduction of the direct oral anticoagulants (DOACs) has not marginalized the AMS. The core AMS functions remain to determine the appropriateness of anticoagulant therapy, manage anticoagulant dosing, provide systematic and ongoing patient monitoring, provide up-front and ongoing patient education, and coordinate with other providers involved in the care of anticoagulated patients. The availability of DOACs has added another critical AMS function which is to assist providers in selecting the correct anticoagulant for an individual patient. This chapter reviews structural elements to support AMS success in the delivery of optimized anticoagulation care.


Warfarin Vitamin K antagonist Anticoagulant Anticoagulation management Anticoagulation program International normalized ratio Prothrombin time Monitoring Management Direct oral anticoagulant 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinical Pharmacy Anticoagulation and Anemia Service, Kaiser Permanente ColoradoAuroraUSA
  2. 2.University of Utah College of PharmacySalt Lake CityUSA

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