Another Medscape article.
The one-page tool, described by Dr. Gladstone and colleagues in their June 30 Annals of Internal Medicine online report, includes:
A: Adherence assessment and counseling
B: Bleeding risk assessment
C: Creatinine clearance (for dosing decisions)
D: Drug interaction assessment and counseling
E: Examination (with focus on blood pressure and fall risk)
F: Final assessment and follow-up
"Anticoagulant management should be viewed as a continuous quality assurance process that depends on a dynamic balance of multiple factors influencing benefit versus risk," Dr. Gladstone said. "Direct oral anticoagulants have safety advantages over warfarin, but still entail risk. Therefore, we advocate regularly scheduled, standardized clinical follow-up assessments and counseling to optimize benefit-risk in long-term DOAC therapy."
"Just because we don't have to monitor an INR (international normalized ratio) for these drugs doesn't mean we don't have to monitor the patient," he concluded.