NHSE&I have published a Clinical guide for the management of anticoagulant services during the coronavirus pandemic – as part of the NHSE&I COVID-19 Collection of Specialty Guides
Patients receiving warfarin requiring management in outpatient or community settings – Anticoagulation service provision should consider the following:
- Is warfarin still required?
- Can patients on warfarin be switched to an alternative oral anticoagulant, e.g. DOAC
- Phased approach over 12-week INR monitoring cycle to protect supply chain.
- Prioritise patients with poor INR control & more frequent checks needed.
- Address non-adherence as possible reason for poor INR control.
- Could patients be trained to self-test INR in their own homes?
- Have blood testing facilities been optimised to reduce risk of infection?
- Strategies to minimise the impact on community nursing services over the next weeks/months
- Suspend warfarin treatment temporarily in selected patients (in whom DOACs
and LMWH are not suitable)
Patients requiring initiation of oral anticoagulation
- Use DOACs where possible.
- Consider brief period of self- or family-injected LMWH for patients with mechanical heart valves when monitoring is not possible and for other patients for whom DOACs are not an option.
- LMWH should only be used if there are no other appropriate options.
- If a patient must have warfarin consider INR self-testing +/- family support with phone dosing advice.
- Issue 28-day quantities and, where possible, use repeat electronic prescribing – larger quantities may compromise the supply chain.
- Hospitals should work to provide prescriptions directly to community pharmacies.