口服抗凝血劑（warfarin；coumadin®；可邁丁錠®）常使用於血栓性疾病，但因為會產生嚴重的副作用（如：出血和栓塞），導致了病人急診或住院的機率增加， 也增加醫療經費的支出。本篇文獻回顧藥師在抗凝血治療門診上的作法與成效，包 括藥師對於口服抗凝血劑治療的病人進行藥事照顧，評估病人的治療需求、擬定照 顧計畫、定期監測 PT/INR 值（prothrombin time  and  international normalized ratio）、 適時  warfarin 劑量調整、病人教育、追蹤評值並與醫師互動。
藥師對於口服抗凝血劑治療的病人進行藥事照顧，藉由用藥教育可以使病人對 自己的藥物治療更進一步的瞭解，而提高了病人服藥的配合度；定期監測病人的 PT/INR 值，並適時調整 warfarin 的劑量，使 INR  值控制在目標值範圍內（INR  = 2.0-3.0），如此一來，就可以預防口服抗凝血劑副作用或併發症的發生，降低 warfarin 導致的不預期門診次數、再次住院率和急診次數，以及減少龐大的醫療支出。所以， 藥師對抗凝血病人執行藥事照顧在國內是值得推廣的專業服務。

Warfarin (coumadin®), an oral anticoagulant, is prescribed widely to prevent and treat arterial and venous thromboembolism. The high risk of such therapy included major hemorrhage and thromboembolic events. Many pharmacist-managed anticoagulant clinics have been established to improve patients’ outcome. Pharmaceutical care services include patient assessment, care plan, monitoring of the prothrombin time (PT) and international normalized ratio (INR), warfarin dosage adjustment, medication management, patient education, follow-up evaluation monitoring, and providing feedback to referring physicians.
The pharmacist-managed anticoagulant clinics can result in increased understanding of therapy by patients, improved compliance, better control of INR (INR=2.0-3.0), and may decrease adverse outcomes, as shown by a reduction in number and cost of warfarin-related hospital readmissions, and emergency room visits. Therefore, pharmacist providing pharmaceutical care is valuable to patients in anticoagulation clinic.