Notes for: Oral AnticoagulantsLast edited [12/08/2013 12:47:19]See NPSA Patient Safety Alert No 18, Anticoagulants
Patient information
- It is essential for the safe use of anticoagulants that patients and carers receive adequate verbal and written information about their treatment. This information should be provided before the first dose of anticoagulant is administered, and reinforced at hospital discharge, at the first anticoagulant clinic appointment, and when necessary throughout the course of their treatment. It is important that the healthcare practitioner who first provides this information records in the patient’s healthcare record that this information has been supplied.
- It is essential that a record (hand-written or computer-generated) of the latest INR test results, dosage information and the next clinic appointment is always made. In Primary Care this is the responsibility of the patient’s GP practice and when the patient is admitted to hospital this is the responsibility of the ward.
- Patients should be encouraged to take their anticoagulation treatment record to all GP, hospital and dental appointments and also to their pharmacy when requesting or collecting their repeat prescriptions.
Warfarin regimens
- All patients on oral anticoagulants should have an annual clinical review.
- Patient and carer groups have informed the NPSA that warfarin regimens with the following characteristics would promote safer use:
- use the least number of tablets each day;
- use constant daily dosing and not alternate day dosing;
- not require the use of half tablets - patients find it difficult to break tablets in half and instead, when necessary, would rather use 500 microgram tablets.
- Doses should be expressed in milligrams and not as the number of tablets.
INR monitoring
Prescribers and pharmacists should check that patients’ INR is being monitored regularly and that the INR level is safe before issuing or dispensing repeat prescriptions for oral anticoagulants.
Co-prescribing medication
When co-prescribing any medicine for patients already on oral anticoagulants, whether or not there is a documented clinically significant interaction, the prescriber should consider making arrangements for additional INR blood tests. Those dispensing clinically significant interacting medicines for these patients should check that these additional safety precautions have been taken.
Care homes
It is safe practice for all dose changes to be confirmed in writing by the prescriber.
Monitored dosage systems (MDS)
A risk assessment should be undertaken on the use of MDS for anticoagulants for individual patients. The general use of MDS for anticoagulants should be minimised as dosage changes using these systems are more difficult.