Management of anticoagulation in clinical practice

This thesis describes various aspects of the anticoagulation management of patients with atrial fibrillation and venous thromboembolism. In this thesis, we focus on the management of direct oral anticoagulants (DOACs). Direct oral anticoagulants inhibit one specific clotting factor and are also known as Non-Vitamin K Antagonist Oral Anticoagulants or Novel Oral Anticoagulants (NOACs). Currently, four different DOACs are available in the Netherlands. Apixaban, edoxaban and rivaroxaban inhibit clotting factor Xa (factor Xa inhibitors) and dabigatran inhibits factor IIa (thrombin inhibitor). There are several clinical indications for oral anticoagulants, of which atrial fibrillation and venous thromboembolism are the most common. The overall aim of the research described in this thesis is to optimize management of oral anticoagulation in clinical practice. The first part of this thesis focusses on the management of oral anticoagulation in non-acute clinical settings and the second part of this thesis on the management of oral anticoagulation-related bleeding complications.