[Anticoagulant prophylaxis: from clinical trials to clinical practice]

Anticoagulant therapy has recently undergone a surge in popularity with the confirmation of its importance in preventing cerebral thromboembolism from atrial fibrillation. Unfortunately oral anticoagulants have an extremely narrow therapeutic index and many physicians are reluctant to treat, particularly old patients, because of the fear of hemorrhagic complications and difficulty of management. The anticoagulant clinic, by improving therapeutic effectiveness and reducing complications, hospitalization and emergency room visits, appears to offer important qualitative and cost advantages over routine medical care. New strategies have been developed for managing care. One promising modality employs patients in their own care by performing their prothrombin time measurement by themselves at home. This model, similar to the way diabetics measure their own blood sugar, is possible as a result of a new class of point-of-care instrumentation for prothrombin testing. These portable monitors can measure a prothrombin time from a finger-stick sample of whole blood and provide a result within seconds. However rigorous studies are necessary to confirm the preliminary results of new management strategies to maximize the benefit-risk ratio of anticoagulant therapy.