Sustainable anticoagulation for climate resilient care.

This Viewpoint issues a multidisciplinary call to embed sustainability into anticoagulation care, aligning clinical excellence with climate responsibility. Anticoagulation management-including drug manufacturing, laboratory diagnostics, therapeutic monitoring, and long-term follow-up-contributes substantially to health-care-associated carbon emissions. We propose a systems-level decarbonisation strategy, anchored in life cycle assessment methodology, to quantify emissions across anticoagulation care and identify high-impact intervention points. Core strategies include reducing unnecessary laboratory testing, greening laboratory operations through recyclable consumables and energy-efficient infrastructure, transitioning to lower-carbon anticoagulants, and promoting antithrombotic stewardship to reduce dosing errors and drug waste. Digital health technologies, such as telemedicine, artificial intelligence, and mobile apps, are positioned as enablers of low-emission, patient-centred care. Circular economy principles and carbon-informed procurement are integrated into the therapeutic pathway, supported by policy levers that incentivise sustainable practices. Finally, we call for inclusive engagement of low-income and middle-income country stakeholders to ensure equitable, scalable, and context-appropriate implementation of climate-resilient thrombosis care.