Transitions of care in patients receiving oral anticoagulants: general principles, procedures, and impact of new oral anticoagulants.

BACKGROUND

Most patients requiring anticoagulation therapy while hospitalized will continue this therapy as outpatients. This transition can be associated with gaps in care related to anticoagulation therapy that increase the risk of adverse events, rehospitalizations, and death. Warfarin, the most commonly used oral anticoagulant, presents distinct management challenges, including drug-food and drug-drug interactions, a narrow therapeutic window, and the requirements for periodic blood monitoring and dose adjustments, particularly during the hospital discharge process.

PURPOSE

This review explores clinical challenges and potential solutions surrounding anticoagulation therapy with warfarin during transitions of care, as well as discusses newer anticoagulants that are approved or are in late stages of development for the prevention of thromboembolic events.

CONCLUSIONS

Diligence, careful planning, and close communication between patients and healthcare providers during and after discharge are required to ensure that patients remain adequately and safely anticoagulated with warfarin in the outpatient setting. New oral anticoagulants may offer the possibility of safer and simpler care for patients requiring anticoagulation.

CLINICAL IMPLICATIONS

We summarize the latest guidelines and recommendations for safe hospital discharge and apply them to the specific case of discharging a warfarin-treated patient. In addition, we discuss the new oral anticoagulants and their potential to offer more efficacious and easier-to-manage anticoagulation.