[Frameworks for responsible anticoagulation care: a contribution to a collective view]

Until recently, vitamin K antagonists (VKAs) were the only form of anticoagulation for the prevention of thromboembolic complications in patients with atrial fibrillation or venous thromboembolisms. Various caregivers are involved in anticoagulation care. Criticism of the support by the thrombosis department focused mainly on the lack of guarantees regarding the interinstitutional anticoagulation chain of care. Initiatives have now been deployed to improve this support, as described in the national integrated anticoagulation care standard (LSKA, Landelijke Standaard Ketenzorg Antistolling) and the national primary care anticoagulation agreement (LESA, Landelijke Eerstelijns Samenwerkingsafspraken). However, rapidly increasing use of direct oral anticoagulants (DOACs) has dramatically altered anticoagulation care. Patients and caregivers are more often confronted with uncertainty about treatment coordination. This article aims to sketch frameworks for responsible anticoagulation care. We examine different topics, such as coordination, organisation of follow-up, availability for answering questions and switching from VKA to DOAC.