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J Thromb Thrombolysis. 2011 Apr;31(3):321-5. doi: 10.1007/s11239-011-0560-2.

Practical management approaches to anticoagulation non-compliance, health literacy, and limited English proficiency in the outpatient clinic setting.

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Anticoagulation Management Service, Massachusetts General Hospital, 275 Cambridge Street, Suite 101, Boston, MA, 02114, USA.


Warfarin is a widely used oral anticoagulant. It is highly efficacious for the treatment and prevention of thromboembolic disorders despite its narrow therapeutic window. Poor compliance with warfarin is common and a major contributor to poor anticoagulation control. A number of psychosocial issues (e.g. depressive symptoms, attitudinal and behavioral factors, cognitive function, lack of social support, limited English proficiency, health illiteracy) have been associated with warfarin non-compliance among patients in anticoagulation clinics. Patient-specific features, such as these, are important to identify in order to develop appropriate and practical interventions. Health literacy and limited English proficiency are the extension of issues related to culture, language, and ethnicity. A better understanding of patients' functioning level and health utilization factors may help to develop and target interventions for high risk patients and reduce complications from suboptimal therapy and poor warfarin management due to non-compliance. Four patient case scenarios will be used to illustrate these issues and identify potential interventions to optimize warfarin therapy.

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