Perspectives: Anticoagulation Management

Sarah A. Spinler

Sarah A. Spinler


  • Professor of Clinical Pharmacy
  • Department of Pharmacy Practice and Pharmacy Administration
  • Philadelphia College of Pharmacy
  • University of the Sciences in Philadelphia
  • Philadelphia, Pennsylvania

The utilization of anticoagulation in patients with atrial fibrillation

I think it’s a huge issue. The most recent data suggests that patients are in therapeutic range less than 40% of the time. There are also problems with maintaining monthly follow up for INR testing.

For example, we see cases of patients admitted or transferred to our hospital, whereby, for various reasons, the patient had not had an INR checked for months but was still taking warfarin. The guidelines recommend at least monthly INR checks. So it is not only the time in the therapeutic range but close monitoring as well that is an issue.

Now, people who deal with this a lot, including thought leaders, are usually familiar with anticoagulation clinics that have excellent patient follow-up, have great overall results at their clinic, and have shown excellent time in therapeutic range. However, in other settings the level of appropriate anticoagulation is very poor.

About the Coagulation Center

The Coagulation Center is an educational resource for healthcare professionals. Guided by a global editorial board of experts, the Coagulation Center offers a range of clinical perspectives on balancing the benefit and risk of anticoagulation in a rapidly changing landscape. Within the Coagulation Center you will find roundtable discussions on anticoagulation management, materials for patient management including patient case studies, tools to help evaluate bleeding risk and stroke risk, and downloadable resources for your practice.