The future of anticoagulation clinics.

The emergence of novel antithrombotic agents may have a dramatic impact on anticoagulation clinics and other providers of anticoagulation services. Of the novel agents currently in development, the oral direct thrombin inhibitor ximelagatran shows the most promise as an agent to improve the field of oral anticoagulation management because it is easier and more convenient to use than warfarin. Ximelagatran is currently being investigated for several indications, including prophylaxis of venous thromboembolism in patients undergoing orthopedic surgery, venous thrombosis treatment, stroke prevention in atrial fibrillation, and acute coronary syndromes. Anticoagulation clinics presently provide systematic, organized management of oral anticoagulation therapy (warfarin in the US) and provide better patient outcomes than usual medical care. The introduction of ximelagatran in patient management may dramatically alter the workload dynamics in anticoagulation clinics. Clinics that will survive the introduction of novel agents will most likely shift from a main focus of warfarin monitoring to thrombotic disease management and coordination of all antithrombotic therapy. Comprehensive Antithrombosis Centers (CAC) will most likely manage patients with thrombotic disorders treated with a range of anticoagulant therapies.