Priority Areas - Anticoagulants in atrial fibrillation - Anticoagulant review

Patients should have the opportunity to discuss anticoagulation and the choice of anticoagulant with their GP annually, or more frequently should there be any changes to bleeding risk or other clinically relevant factors.

A review with the patient also provides the opportunity to improve adherence to treatment and to reinforce knowledge regarding drug and food interactions. Warfarin and the DOACs require vigilance due to potentially severe complications of poor compliance and interactions.

Anticoagulant review table

  • The review of patients with AF who are taking an anticoagulant is vital.
  • The use of any anticoagulant is associated with some drug-drug interactions which may increase the risk of serious bleeding or diminish stroke prevention.
  • The NICE guideline Atrial fibrillation: management highlights the need to review anticoagulation and the quality of anticoagulation at least annually, or more frequently if clinically relevant events occur affecting anticoagulation or bleeding risk.
  • Quality Statement 3 within the NICE Quality Standard for Atrial fibrillation states that adults with atrial fibrillation who are prescribed anticoagulation should discuss the options with their healthcare professional at least once a year.
  • Patients should have the opportunity to discuss the choice of suitable anticoagulants with their healthcare professional, in order to improve adherence to treatment.
  • Adherence to anticoagulation can help to prevent stroke by reducing the likelihood of a blood clot forming.

Percentage of patients with AF who are prescribed an anticoagulant and have received an anticoagulant review within the last 12 months – September 2019

Graph 20 Anticoagulant review

How can changes be made?

  • Review patients on anticoagulation therapy at least annually, or more frequently if clinically relevant events occur affecting anticoagulation or bleeding risk.
  • Ensure that appropriate read codes are used when reviewing patients
  • A practice template could be developed to ensure that all relevant factors are considered when reviewing anticoagulants.

 


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