0
Editorials |

Strategies to Improve Oral Anticoagulation ManagementImproving Oral Anticoagulation Management

Danielle E. Smith, MSc; Gregory Y. H. Lip, MD; Deirdre A. Lane, PhD
Author and Funding Information

From the University of Birmingham Centre for Cardiovascular Sciences, City Hospital.

Correspondence to: Deirdre Lane, PhD, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Dudley Rd, Birmingham, B18 7QH, England; e-mail: deirdrelane@nhs.net; d.a.lane@bham.ac.uk


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Lip has served as a consultant for Bayer, Astellas, Merck, AstraZeneca, Sanofi-Aventis, Bristol-Myers Squibb/Pfizer, and Boehringher Ingelheim and has been on the speakers bureau for Bayer, Sanofi-Aventis, Bristol-Myers Squibb/Pfizer, and Boehringher Ingelheim. Dr Lane has received funding for research, educational symposia, consultancy, and lecturing from Bayer Schering Pharma AG, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, and AstraZeneca. Ms Smith has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(2):281-282. doi:10.1378/chest.11-0418
Text Size: A A A
Published online

Extract

Oral anticoagulation (OAC) therapy with vitamin K antagonists is beset with numerous difficulties due to the narrow therapeutic window, slow onset and offset of action, and various food, drug, and alcohol interactions, which necessitate regular monitoring of the patient’s international normalized ratio (INR) to reduce the likelihood of thromboembolic and/or bleeding complications associated with subtherapeutic and supratherapeutic therapy, respectively. After initiation of OAC therapy, the most important objective is achieving (and maintaining) a therapeutic INR and improving the percentage of time spent in the therapeutic range (TTR). Several analyses of randomized controlled trials,1-3 observational studies,4-6 and a meta-analysis7 have demonstrated that the greater the TTR, the fewer adverse events, with the minimum TTR necessary to achieve clinical benefit of around 65%.1-7 What can we as health-care professionals do to improve TTR? One strategy is the frequency of INR testing; however, there is a paucity of evidence on the optimal time between INR tests needed to achieve good INR control, and there is no consensus between the major guidelines.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543