Anticoagulation therapy is well established, yet managing patients in this therapy can still be challenging. Direct oral anticoagulants (DOACs) with less drug interactions, fixed dosing and no need for routine coagulation monitoring continue to rise in prescription numbers across the UK. However, the shift to DOACs poses new challenges for clinicians.
We consulted key opinion leaders on the anticoagulation and Atrial Fibrillation fields on how these challenges might be solved. We collated their insights into Exploring emerging issues in anticoagulation therapy, a collaborative discussion paper that examines:
In our discussion paper, we aim to start an informed debate on how this can be can achieved for patients in long-term anticoagulation therapy.
We asked our INRstar users what challenges they experience when managing patients on DOACs. They told us that the most common ones are:
The impact of excellent anticoagulation services on population health and reduction of budget pressure is significant, but is there consensus on the best care pathway for patients on anticoagulants? How can patients be supported and optimally managed?
Great efforts to deliver excellent anticoagulation care are taking place. In our discussion paper we take a close look at two case studies:
Structured reviews, patient engagement in their health management and adherence are some of the emerging issues of this therapy. Additionally, care teams may need to develop more robust ways of monitoring patients on DOACs and yet for other patients, vitamin K antagonists might still play a role. Better ways of providing convenient, safe dosing advice and monitoring may need to be developed for these patients. Read our collaborative discussion paper to find out more.
Joint decision making and an ongoing relationship between patient and care team which involves continuous and comprehensive education for both is the way forward. In the future, we will examine how technology can enable and support this.
Meanwhile, why not read our discussion paper to find out more?
1 INRstar user survey April 2017, 1437 respondents.
2 National Institute for Health and Care Excellence. ‘Anticoagulation – oral.’ Last revised: December 2016. Last accessed: 23 October 2017. Available at: https://cks.nice.org.uk/anticoagulation-oral
3 Jackevicius C. A., Tsadok M. A., Essebag V. et al. ‘Early non-persistence with dabigatran and rivaroxaban in patients with atrial fibrillation’. Heart. 2017:103:1308–1309. Originally published: 07 Apr 2017. doi: 10.1136/heartjnl-2017-311305