Management of oral anticoagulant therapy in Italy

The clinical outcome of oral anticoagulant therapy (OAT) depends on how successful physicians and patients are in achieving and maintaining levels of anticoagulation capable of preventing thromboembolic events without increasing the risk of hemorrhagic complications. Concerning the patient, education and compliance are the major problems. Concerning the physicians, the management of patients receiving OAT is a complex task that requires frequent laboratory testing, dosage regulation, prompt diagnosis, and treatment of thromboembolic and hemorrhagic events. Anticoagulation clinics, which provide patient education, close monitoring of prothrombin times and continuous clinical surveillance, have been claimed to help in improving the overall quality of OAT. In 1989, following the experience of other countries, a national Federation of Centers for the Surveillance of Anticoagulant (FCSA) therapies was founded in Italy. In the last 10 years the main objectives of FCSA have been: (1) favoring the development of new centers in areas of the country lacking proper services; (2) standardazing the management of OAT by recommending organizational and technical procedures; (3) stimulating participation in laboratory quality-control programs; (4) implementing continuous education programs for medical and paramedical personnel and for the patients themselves; (5) making health administrators aware of the social impact of OAT and of the need for the formal recognition of the centers; and (6) planning and organizing multicenter studies. Some of these goals have been successfully achieved, but problems remain to be solved to guarantee an optimal control of OAT in the entire national territory.