In the last decade the indications of oral anticoagulant therapy (OAT) have increased significantly. The type of management can improve the quality of OAT treatment. We can define four different types of management: 1) Anticoagulation Clinic (AC), 2) routine medical care (RMC), 3) self- testing (PST), and self-management (PSM). Anticoagulation clinics (AC) are services organised to provide patient education, laboratory monitoring, to manage bleeding and thromboembolic event, changes in patient habits, inter-current diseases and co-medications. The aim of AC is to reduce complications tailoring to the single patient. Several studies have shown that anticoagulation management by AC results in better control of anticoagulation compared with routine medical care (RMC), with a 50 to 75% reduction of major bleeding and thrombotic complications. Well selected and trained patients on long-term oral anticoagulant therapy now also have the option of PST or PSM, performing PT INR with portable monitor, even if no more than 20% of patients can be considered for PSM. Because of the substantial increase in the number of patients followed up at AC, In the last few years we observed different strategies for decentralizing OAT management, mainly through telemedicine systems, connecting AC to general practitioners or to health care districts. These new organizations aim to achieve the following advantages: 1) maintain the same patient's clinical quality levels, 2) establish a direct communication between general practitioners and AC, 3) improve patient's satisfaction and quality of life, 4) continuing medical record update.