Anticoagulation management today: pitfalls and solutions
Ellen Murray
pp 1-5
The recently updated National Institute of Health and Care Excellence (NICE) guidelines for atrial fibrillation (AF) recommend treating more AF patients, and people with additional risk factors, with anticoagulation therapy for stroke prevention. As a result, the number of people receiving oral anticoagulation will continue to increase.
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Comment: IVC filters: the enthusiasts and the reticents
Peter Rose
pp 2-2
There is marked variation in the use of inferior vena cava (IVC) filters in UK hospitals and an even greater variance when comparing IVC filter use between countries. To the protagonist (usually enthusiastic interventional radiologists), IVC filters are a panacea for the prophylaxis of venous thromboembolic disease and an adjunct to the acute treatment of venous thromboembolism (VTE). To others, however, they are considered to be a last resort when all other measures are contraindicated or exhausted. It is a challenge to understand how views have become so polarised, and what this means for everyday practice.
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Debunking myths about fruit juices and warfarin
Sarah Bond
pp 6-7
Under the section ‘Things which affect warfarin’, the current patient information leaflet for warfarin lists cranberry juice, cranberry products and possibly grapefruit juice, as things that increase the effect of warfarin. Patients are advised not to consume any of these products while taking warfarin. But how much evidence is there to warrant advising all patients taking warfarin to avoid these products?
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The benefits of thromboprophylaxis
Victoria Price and Nicola Curry
pp 8-11
Between 5–10% of all in-hospital deaths are a direct result of venous thromboembolism (VTE), and as many as 10–20% of all medical inpatients can be expected to develop a VTE secondary to hospitalisation. In 2009, the Department of Health launched the National VTE Prevention Programme aimed at reducing avoidable morbidity, disability and death from hospital associated VTE.The central tenet of the programme was to implement VTE risk assessment for all inpatients and prescribe appropriate thromboprophylaxis (TP). The benefits of this national programme are now evident; a 12% reduction in hospital acquired thrombosis was shown when compliance with VTE risk assessment rates were =90%. A UK wide study also showed a reduction in VTE-related secondary diagnoses and readmissions, together with an 8–9% reduction in VTE-related mortality.
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Update on the V300 non-medical prescribing course – an anticoagulant nurse’s perspective
Donna Sydenham
pp 12-13
Nurse prescribing is well established in the UK as a mainstream qualification, with over 54,000 nurse and midwife prescribers and over 19,000 nurse independent and supplementary prescribers. Extended independent prescribing (now known as non-medical prescribing) has been shown to be beneficial in providing patients with safe and prompt access to treatment and medicines.
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How do you define instability in warfarin patients?
David Fitzmaurice
pp 14-14
What this question is really asking is ‘is my patient getting benefit from warfarin?’ The benefit of warfarin is maximal within its therapeutic window, which is generally an international normalised ratio (INR) range of 2–3 with a target of 2.5. The more time the patient spends within this range the better. We know that if a patient spends less than 50% of their time within this range they would be better off receiving no therapy.
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Developing a nurse-led ultrasound scanning service to diagnose DVT in primary care
Jo Boyd
pp 15-15
SEQOL provides a nurse-led community deep vein thrombosis (DVT) service for patients within Wiltshire and surrounding counties, seeing on average 1,400 patients annually. Between June 2012 and June 2013, only 20.4% of patients seen in the SEQOL urgent care centre received an ultrasound scan within 24 hours of referral. A total of four scans were available to the DVT service every day from the secondary care providers of ultrasound scans, with no capacity for peaks and troughs in attendance numbers. The DVT service had an average daily requirement of 4.2 scans, resulting in long waits and the excessive use of low-molecular-weight heparin (LMWH) while patients awaited definitive diagnoses.
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