Management of anticoagulant therapy: The dutch experience

In the Netherlands, outpatient oral anticoagulant therapy is monitored by a system of specialized anticoagulation clinics whose purpose is to make anticoagulant therapy as safe and effective as possible. In this paper we present the daily routine in one of these anticoagulation clinics (the Leiden clinic), which serves a catchment area with about 500,000 inhabitants. Several levels of quality control can be distinguished in the anticoagulation clinic. One level is the evaluation and standardization of laboratory methods, which includes participation in multicentered quality assurance programs. A second level is therapeutic quality control, which is the evaluation of how well a clinic maintains the patients within the specified target range of anticoagulant intensity. A third level is clinical quality control, which includes clinical outcome research. Outcome research includes studies into complications associated with treatment (e.g., bleeds), risk factors of treatment, and the optimal intensity of anticoagulant treatment.