Hot topics

ExPeKT publication

The ExPeKT Study (Exploring Prevention and Knowledge of VTE) have had an article published on BMJ Open:

McFarland L, Murray E, Harrison S, Heneghan C, Ward A, Fitzmaurice D & Greenfield S "Current practice of venous thromboembolism prevention in acute trusts: a qualitative study" BMJ Open 4:e005074 doi:10.1136/bmjopen-2014-005074

You can read the full article here

NICE guidelines on the management of Atrial Fibrillation published

NICE clinical guideline CG180 Atrial Fibrillation: the management of Atrial Fibrillation has been published and is available to view on the NICE website. The guideline updates and replaces NICE clinical guideline 36 and offers evidence-based advice for the care and treatment of people with AF.

You can also read the press release here

The following related article was also published in the BMJ this week:

Jones C, Pollit V, Fitzmaurice D, and Cowan C "The management of atrial fibrillation: summary of updated NICE guidance" BMJ 2014;348:g3655 doi: 10.1136/bmj.g3655 (Published 19 June 2014)

The full article can be viewed here


NICE Diagnostics consultation document published

Point-of-care coagulometers (the CoaguChek XS system and the INRatio2 PT/INR monitor) for self-monitoring coagulation status in people on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve disease

Provisional recommendations:
1.1 The CoaguChek XS system is recommended for self-monitoring coagulation status in people on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve disease if:
- the patient prefers this form of testing and
- the patient or their carer is both physically and cognitively able to do the self-monitoring

1.2 For people who may have difficulty self-monitoring, such as children or people with disabilities, their carers should be considered to help with self-monitoring. Patients and carers should be trained in the effective use of the CoaguChek XC system and their ability to self-monitor should be regularly reviewed. Equipment for self-monitoring should be regularly checked using reliable quality control procedures.

1.3 The INRatio2 PT/INR monitor is only recommended for use in research for self-monitoring coagulation status in people on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve disease.  Research is recommended into the clinical benefit and cost effectiveness of using this point-of-care coagulometer (see section 7.1)

National Institute for Health and Care Excellence. Issue date: February 2014.

The full document is available to view on the NICE website


Who should be managing Anticoagulation therapy?

We are constantly being asked about the role of Health Care Assistants in anticoagulation management. In answer to this question please see the links below to 3 useful documents published by the National Patient Safety Agency (NPSA) and the Royal College of Nursing (RCN):

"Anticoagulant competence 2: Maintaining oral anticoagulant therapy" National Patient Safety Agency 2007

"The nursing team: Common goals, different roles" Royal College of Nursing 2012. Publication number 004 213

"Accountability and delegation: What you need to know. The principles of accountability and delegation for nurses, students, health care assistants and assistant practitioners" Royal College of Nursing 2013. Publication number 003 942


A new UK study showing we are still not managing our AF patients very well

"The use of anticoagulants in the management of atrial fibrillation among general practices in England"
Cowan C, Healicon R, Robson I, Long WR, Barrett J, Fay M, Tyndall K, Gale CP

Abstract

"Objectives: To investigate the use of oral anticoagulants (AC) and antiplatelet agents (AP) in the management of atrial fibrillation (AF) among patients in primary care in England.

Design: Epidemiological study

Setting: 1857 general practices in England representing a practice population of 13.1 million registered patients.

Patients: 231, 833 patients with a history of AF.

Main outcome measures: The primary outcome was AC and AP use by CHADS2 score and age groups < 30 years, 30-49 years, 50-64 years, 65-79 years and >79 years.

Results: 231, 833 patients with a history of FA were identified, giving a prevalence among uploading practices of 1.76%. Prevalence of AF varied markedly between practices, related to differing practice age profiles. The total number of patients with AF in a practice was strongly predicted by the number of patients aged 65 years and over in the practice. 57.0% of the AF population had a CHADS2 score ≥2 and 83.7%≤1. 114, 212 (49.3%) patients received AC therapy. AC uptake increased with increasing CHADS2 score up to a score of 3, but thereafter reached a plateau. Among 132,099 patients with a CHADS2 score ≥2, 72,211 (54.7%) received an AC, 14,987 (11.3%) were recorded as having a contraindication or having declined AC therapy, leaving 44,901 (34.0%) not on AC therapy and without a recorded contraindication or recorded refusal. Among patients not prescribed an AC, 79.9% were prescribed an AP. The use of AC declined in the elderly (for CHADS2 ≥2, 47.4% of patients ≥80 years, compared with 64.5% for patients aged <80 years, p<0.001). By contrast, AP uptake was more prevalent among elderly patients.

Conclusions: Over one-third of patients with AF and known risk factors who are eligible for AC do not receive them. There is a high use of AP among patients not receiving AC. Uptake of AC is particularly poor among patients aged 80 years and over."

Cowan C, Healicon R, Robson I, Long WR, Barrett J, Fay M, Tyndall K, Gale CP "The use of anticoagulants in the management of atrial fibrillation among general practices in England" Heart 2013 99: 1166-1172 (originally published online February 7, 2013)

The full article can be viewed here

ESC guidelines for Atrial Fibrillation

The Task Force for the Management of Atrial Fibrillation of the The European Society of Cardiology (ESC) have produced new guidelines for Atrial Fibrillation (AF) the most common sustained cardiac arrhythmia, occurring in 1–2% of the general population.

The committee was chaired by John Camm and included Gregory Lip, Dan Atar, Raffaele de Caterina, Gerhard Hindricks, Stefan Hohnloser, Paulus Kirchhof, Irina Savelieva

The guidelines include the following :
1. Stroke and bleeding risk assessment scores, CHA 2DS 2-VASc and HAS-BLED
2. New oral anticoagulants
3. Left atrial appendage closure
4. Cardioversion with pharmacological agents
5. Catheter ablation of atrial fibrillation

Please follow this link to the ESC website for full information

British Committee for Standards in Haematology Guidelines

The British Committee for Standards in Haematology (BCSH), a sub-committee of the British Society of Haematology have now made available via their website 4th edition guidelines.

Please visit the BCSH website for details

NICE guidance - Venous thromboembolic diseases

New guidance published by NICE aims to clarify which tests and treatment produce the most clinically and cost effective diagnosis & management of venous thromboembolic diseases.

The full guidance can be viewed here

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