Anticoagulation: where we are and where we need to go.

Although a commonly prescribed medication, warfarin has unique pharmacologic properties that make dosing challenging for many primary care physicians. When a patient's international normalized ratio (INR) is out of the therapeutic range, they are at increased risk for thrombotic or hemorrhagic complications. We have reviewed the current literature for quality improvement techniques to minimize adverse outcomes and improve anticoagulation care. The use of anticoagulation clinics, computer-guided dosing and patient self-monitoring have been demonstrated to reduce adverse events or improve patient and provider satisfaction. Additional techniques, including genetic-based dosing, concurrent vitamin K administration and development of risk-assessment tools, have been discussed, but not fully developed or assessed in the literature. We identify tools that can be implemented today as well as those currently under development for the improvement in anticoagulation care.