New discussion paper on emerging issues in long-term anticoagulation therapy

Posted by LumiraDx Care Solutions in Blog
On 16 November 2017

Exploring emerging issues in anticoagulation therapy discussion paper

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:

  • Unanswered questions about the future of anticoagulation
  • Best practice, adherence and education and patient choice for DOACs
  • What affects adherence for patients on long-term therapies
  • Innovative approaches taking place to support excellent anticoagulation services

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.

Top 3 challenges of managing patients on DOACs1

We asked our INRstar users what challenges they experience when managing patients on DOACs. They told us that the most common ones are:

  1. Making sure patients are regularly reviewed
  2. Patients forgetting or missing doses
  3. Ensuring annual blood tests are done

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?

NICE recommends patients on DOACs should be reviewed every three months

Initiatives to support adherence for patients on DOACs

Great efforts to deliver excellent anticoagulation care are taking place. In our discussion paper we take a close look at two case studies:

1 in 3 patients become non persistent within 6 months

  1. Birmingham: A nurse-led clinic in primary care is demonstrating how structured follow up can deliver excellent patient care and safety
  2. Swindon: A joint initiative brings together secondary care, a local pharmaceutical committee and the New Medicines Service to ensure that follow up is carried out

Read more about these initiatives in our collaborative discussion paper

Key insights about management of patients on DOACs

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:

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

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Posted by LumiraDx Care Solutions

LumiraDx Care Solutions is the home of INRstar, the UK’s market-leading anticoagulation clinical decision support software (CDSS) and engage, the patient app, which offers a range of self-care programmes for long-term conditions. engage was ‘Highly Commended’ in the Best Healthcare App category of the Building Better Healthcare Awards, November 2017.

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