Tag Archives: noac

NOACs contraindicated in patients with mechanical heart valves

Prescribers are reminded not to substitute newer oral anti-coagulant drugs (NOACs) for warfarin in patients with mechanical heart valves under any circumstance because of the risk of thromboembolic and bleeding events, regardless of the length of time since the replacement.  This warning relates to any of the drugs in this class (dabigatran, edoxiban, rivaroxiban and apixiban).

Please refer to the Summary of product Characteristics for each drug for full prescribing information.

http://webarchive.nationalarchives.gov.uk/20150122075153/http:/www.mhra.gov.uk/home/groups/dsu/documents/publication/con254819.pdf

Important Update to the County Durham and Darlington DVT Pathway

We have become aware that some practices were either not using the County Durham and Darlington DVT Pathway, or were using an incorrect version and this had led to a serious untoward incident. As a result we have taken the opportunity to review the Pathway and to re-launch it so everyone is now using the correct version. Most of the changes are subtle, but there are a few important points we want to emphasise:

  • Please ensure that you only use the most up to date version of the County Durham and Darlington DVT Pathway and that you delete any previous versions.
  • It’s really important to familiarise yourself with the changes to the Pathway, as this incorporates lessons learned from a serious untoward incident.

Summary of Key Changes

1. Greater emphasis has been placed on the following:

That patients with a negative initial ultrasound scan, but a positive d-dimer will have their treatment stopped until the results of the second scan, 6-8 days later, are known.

This is because the patient will have one of the three scenarios below:

  1. Not have a DVT at all
  2. Have an isolated calf vein DVT that would not have extended, or
  3. Have an isolated calf vein DVT that would have extendedNot

Giving anticoagulation for the week is unnecessary for 1 and 2. In 3, continuing treatment would very likely stop extension for the week it is given (making the second scan pointless as it will be negative). When anticoagulation is then stopped the clot may then extend proximally and remain untreated – one week of anticoagulation being insufficient.

A repeat scan should be booked via 111 for 6 – 8 days after the initial scan and this should be recorded on the second page of the patient held record.

2. Guidance to seek secondary care advice strengthened

Unless you are happy this is a provoked distal DVT we strongly recommend you seek advice on duration of treatment and further investigations either by referring to haematology or communicating with your local haematologist.

3. For patients receiving rivaroxaban, there is now a NOAC patient alert card and this has been added to the guidance:

In addition to the DVT patient held record, the patient will also carry a NOAC patient alert card which should be given to the patient with the starter packs, or will be supplied by the pharmacy if a prescription is given. In addition patients should also be counselled to let other health care professionals, such as dentists, involved in their care, know that they are taking rivaroxaban.

Click here for further information on the NOAC alert card from the Northern England Strategic Clinical Networks.

GP practices and community pharmacies can request a supply of the NOAC alert cards by emailing england.nescn@nhs.net.

Novel Oral Anticoagulant (NOAC) Alert Cards

The Cardiac Advisory Group of the Northern England Strategic Clinical Networks are in the process of distributing and publicising a generic NOAC Alert Card they have developed to clearly inform patients and healthcare professionals of key safety information regarding the use of novel oral anticoagulants (NOACs).

Primary and secondary care pharmacists have been asked to issue the card to patients when they issue the prescription.

If your practice would like a supply of the NOAC Alert Card to issue yourselves please email england.nescn@nhs.net to request these.

The card includes advice to the patient about what symptoms and signs should concern them and who to contact if problems develop with clear lines of responsibility. Useful information for healthcare workers includes the indication and duration for the treatment and advice on how to manage common complications and concerns.

The card was developed in consultation with all stakeholders within our clinical networks as a standardised and easily recognisable tool for use across the region.

To read more, and see an example of the card, please use the link below:

http://www.nescn.nhs.uk/wp-content/uploads/2015/02/NOAC-Alert-Card-Initiative1.pdf