We all know how important it is to prescribe the right anticoagulants for patients at risk of strokes or heart attacks. Vitamin K antagonists like warfarin have very much been the “go-to” option of choice for oral anticoagulants for more than fifty years. This changed with the introduction of direct-acting oral anticoagulants (DOACs), one of the key innovations in the field.
There is some clinical evidence to suggest that DOACs are at least as safe and effective as vitamin K antagonists such as warfarin. (1) Randomised controlled trials for stroke prevention and thrombosis management reveal significant real-world data showing similar outcomes. (1)
It has also been argued that DOACs have several clinical advantages over warfarin, including the speed of the anticoagulant effect, the fixed nature of the dosing and lack of monitoring requirements. (1) This has led several figures in the industry to regard DOACs as an attractive option for anticoagulation, leading to their widespread popularity as a long-term treatment.
The recommendations for the use of anticoagulation tests for DOACs, are often confusing, contradictory and fail to address safe medical interventions. (2) Indeed, recent research has suggested there are safety issues with the current testing system for DOACS, which may not adequately meet the safe-for-treatment threshold. (2)
This has led to a deficit in DOAC-specific coagulation testing. (2) This means that while not needing to monitor DOACs may initially seem advantageous in terms of time and costs, it is potentially problematic and may complicate the treatment patients receive in medical emergencies like ischemic or haemorrhagic stroke. (2) In these life-threatening situations, where urgent surgical intervention may be required, healthcare professionals need access to as much information as possible to make effective treatment decisions.
Incorrect DOAC dosing has important efficacy and safety implications. Risk of embolic events and potentially preventable strokes may occur if dosing is too low, while using a higher dose where the renal function indicates that a dose reduction is necessary may increase the risk of bleeding. (3)
While a lot has changed in the world of anticoagulants over the years, the importance of monitoring and patient safety hasn’t.
One of Hart Biologicals’ key areas of expertise is the field of INR monitoring. We supply vital equipment and reagents to support regular blood testing of warfarin patients, to ensure they are compliant with dosage and, if needed, appropriate adjustments can be made.
Our MC device Thrombi-Stat offers a safe clinic-based testing method for patients on warfarin. This gives patients an ongoing check-up to provide them with peace of mind and gives the clinician the ability to make evidence-based interventions.
Moreover, our approach to testing is not only quick, delivering rapid results in two minutes, but it is also cost-effective at less than 30p per test. This is far cheaper than alternatives, such as dry chemistry strip testing, which cost £2-3 each. By using our wet chemistry test method, we alleviate the cost and time concerns some healthcare professionals have with anticoagulation monitoring. Our testing system can also be used in community-based settings such as GP surgeries, pharmacies, and community clinics; providing health services with a more patient-centred option.
When it comes to using anticoagulants, we must not forget the vital importance of monitoring for patients and clinicians alike. At Hart Biologicals we pride ourselves on supporting positive monitoring experiences and clinical care by providing reliable, cost-effective products our customers and their patients can depend on.
To learn more about running an efficient, cost-effective anticoagulation clinic, check out our how-to guide
References
1. Sikorska J, Uprichard, J. Direct Oral Anticoagulants: A Quick Guide. Eur Cardiol. 2017 Aug;12(1):40-45. doi: 10.15420/ecr.2017:11:2. PMID: 30416551; PMCID: PMC6206466. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6206466/
2. Ebner M et al. Emergency Coagulation Assessment During Treatment With Direct Oral Anticoagulants Limitations and Solutions. 2017 American Heart Association, Inc. Stroke DOI: 10.1161/STROKEAHA.117.017981 Available online: https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.117.017981
3. Specialist Pharmacy Service (NHS), DOACs in Renal Impairment: Practice Guide to Dosing Issues Vs3, Feb 2020 (AW) Available online from: https://www.sps.nhs.uk/wp-content/uploads/2019/07/DOACs-in-Renal-Impairment-Practice-Guide-to-Dosing-Issues-v3-Feb-2020-AW.pdf
