COVID-19 – Anticoagulant Services Clinical Guide

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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.