Anticoagulant therapy is complex and associated with both substantial benefits (reduced risk for thrombus extension and fatal pulmonary embolism [PE] in the setting of acute illness and recurrent venous thromboembolism [VTE] thereafter) and risks (life-threatening bleeding complications).1 Recognizing and mitigating risk for harm from anticoagulants requires an evidence-based approach to anticoagulant management and patient education. These guidelines focus on the optimal management of anticoagulant drugs for the prevention and treatment of VTE following the choice of an anticoagulant. Key management strategies for optimal use of anticoagulants include initial anticoagulant dose selection (recommendation 1), drug-interaction management (recommendation 2), point-of-care international normalized ratio (INR) testing (recommendations 3 and 4), INR recall interval selection (recommendations 5 and 6), laboratory monitoring of the anticoagulant response (recommendations 7-9), transitions between anticoagulants (recommendation 10), the use of specialized anticoagulation-management services (AMSs) (recommendation 11), structured patient education (recommendation 12), efforts to improve adherence to anticoagulant medication regimens (recommendations 13a-d), invasive procedure management (recommendations 14 and 15), excessive anticoagulation and bleeding management (recommendations 16, 17, 18a and b, 19, and 20), anticoagulant resumption following bleeding (recommendation 21), and renal function monitoring (good practice statements). These guidelines are based on updated and original systematic reviews of evidence developed under the direction of the McMaster University GRADE Centre. The panel followed best practice for guideline development recommended by the Institute of Medicine and the Guidelines International Network.2-5 The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach6-12 to assess certainty in evidence and formulate recommendations.
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