CPDIN
FOCUS
MODULE 2
Strict adherence to DOAC intake is crucial as its anticoagulant effect wanes within 12-24 hours after last intake
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• Do not put dabigatran into a compliance aid.
• Take care with other prescribed medications, eg macrolide antibiotics, oral anti-fungals, NSAIDs, etc.
• Counsel on OTC medicines. It’s tempting to be more complacent about potential interactions with DOACs compared with warfarin but caution is still required with the usual suspects, eg aspirin, oral or topical NSAIDs, etc.
• Report back any significant findings from discussions, to prescribing GP or practice- based pharmacist.
It is likely that patients who have switched from warfarin to a DOAC will benefit from extra care. Whilst it’s
20 - PHARMACY IN FOCUS
possible they may be grateful for the discontinuation of the 6-weekly blood tests, and for the somewhat shorter list of drug-drug and drug-food interactions to be aware of, there may be some unexpected drawbacks. If the switch has been to apixaban or dabigatran, then it could be a challenge to remember BD dosing, instead of once daily at 6pm. [Although, in fairness, many of these patients are likely to be taking multiple medications, so BD dosing may not be a consideration.] Some patients interpret their INR as a confirmation that their anticoagulant has been working, and to suddenly experience the absence of regular blood tests may dent their faith in the treatment. Also some warfarin patients actually enjoy the social experience of their
regular trips to the warfarin clinic, and so miss it when it’s no longer part of their regime.
These are all reasons and opportunities for the pharmacist to reassure and to reinforce the new regime.
1, 19, 20. BEAT [Bringing Experts together in Anticoagulation] June 2017 2. Stroke Association Guide to AF and Stroke 2018 3.
CHADS-VASc.org official site 4. NICE Decision Aid for anticoagulation in AF 5, 8,12,13,14,15,16,18. The European Heart Rhythm Association Practical Guide on the use of non-vitamin K. antagonist oral anticoagulants in patients with atrial fibrillation. 6, 7,10,11, 17. NICE Guidance on oral anticoagulation last revised November 2017. 9. Elquis Prescriber Checklist
TAKE THE 5
MINUTE TEST To receive your CPD logsheet and certificate;
Visit
www.pharmacyinfocus.co.uk/ education
Register your details for the relevant module; Anti- coagulation, Module 2
Having studied the module and without referring to it again complete the 5 minute test. If you need to refer to the text to answer the questions then you may need to study the module again.
ASSESSMENT: Upon completion of the test your answers will be scored and if you are successful you will be issued with your CPD certificate.
*Downloadable PDF of this module is available online the Pharmacy in Focus Website for your records
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