Delivery of Optimized Anticoagulant Therapy:

Millions of patients receive anticoag-ulant therapy to prevent or treat thromboembolism. High-quality evi-dence documenting the benefit of an-tithrombotic therapy for patients with mechanical heart valves, a history of ve-nous thromboembolism, or atrial fibrilla-tion is abundant.1-3 However, antithrom-botic agents are associated with a risk of bleeding. On death certificates, anticoag-ulants ranked first in 2003 and 2004 in the number of total mentions of “deaths for drugs causing adverse effects in ther-apeutic use.”4 In the US, the Joint Commission has brought significant attention to the safety of antithrombotic agents by challenging hospitals to “reduce the likelihood of pa-tient harm associated with the use of an-ticoagulation therapy ” as 1 of 2 new Na-tional Patient Safety Goals for 2008.5 Warfarin, the only oral anticoagulant available in North America, is notorious for having both a narrow therapeutic in-dex as well as numerous drug and dietary interactions.6-10 The fear of bleeding com-plications and the need for frequent blood sampling are among the reasons that oral anticoagulant therapy is underutilized.11-14 The safety and effectiveness of both short- and long-term anticoagulation ca