Long-term monitoring of direct oral anticoagulants: A primary care audit

Amendra, Damian and Nikitina, Akvile (2018) Long-term monitoring of direct oral anticoagulants: A primary care audit. In: RSM Venous Forum annual meeting 2018, 2018-06-27.

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Abstract

Aims: To investigate whether patients on direct oral anticoagulants (DOACs) in an urban GP practice were being monitored long-term in accordance with NICE guidelines.   Methods: The NICE guidelines on anticoagulation recommends that all patients taking a DOAC for >12 months should receive monitoring of FBC, U&Es and LFTs, or more frequent monitoring in acute illness or renal impairment. A standard of 85% was agreed at a practice meeting. A SystemOne search was conducted for ‘on repeat prescription medications’ apixaban, rivaroxaban, dabigatran and edoxaban between 12/10/13 and 12/10/16. Laboratory investigations were analysed; patients were excluded if they had not been on a DOAC for >12 months. The findings were analysed and discussed at a practice meeting. A subsequent re-audit was undertaken three months following quality improvement interventions.   Results: 29 patients met the inclusion criteria. 13 (45%) had been appropriately monitored according to NICE guidelines. Following intervention, this improved to 20/33 (61%).   Conclusions: Direct oral anticoagulants (DOACs) are a relatively new class of anticoagulants. The proportion of patients on DOACs is increasing as they replace warfarin in an ageing population. They are primarily initiated in the secondary care setting and monitored in primary care.These results suggest that patients on DOACs were not being fully investigated long-term, with the potential to result in adverse bleeding events. The instigation of a reminder on SystemOne improved performance in this area, albeit still below the set standard. As rates of DOAC prescription increase, this audit highlights the importance of long-term monitoring and an area for significant clinical improvement.

Item Type:	Conference or Workshop Item (Other)
Depositing User:	LivePure Connector
Date Deposited:	03 Feb 2025 15:07
Last Modified:	17 Feb 2025 12:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/98358
DOI:

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