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Anticoagulation

Blood clots

Anticoagulants are prescribed to help prevent blood clots in those at risk of developing them, including people with artificial heart valves or atrial fibrillation, those who have had a heart attack or stroke and those at risk of deep vein thrombosis or pulmonary embolism. Warfarin is the most commonly prescribed anticoagulant but requires regular coagulation monitoring and has numerous interactions with other drugs and food. Four new oral anticoagulants (NOACs) are also available in the UK, which have a more predictable therapeutic response, a more rapid onset of action, fewer drug interactions and no requirement for regular coagulation monitoring. On this page you will find news stories and articles relating to anticoagulants, which cover the development and licensing of NOACs and the management of patients taking both NOACs and warfarin. Our research article also examines the impact of a pharmacist-led anticoagulant review clinic for high-risk patients.

CPD and research articles

SEM of activated platelets

Heparin-induced thrombocytopeniaSubscription

By , ,

Heparin is widely used for thromboprophylaxis or as a treatment in many clinical situations, however, it can cause serious adverse effects. Heparin-induced thrombocytopenia (HIT), an immune-mediated adverse drug reaction, is associated with high morbidity and mortality if undiagnosed.

News and events

Leyla Hannbeck, former director of pharmacy at the National Pharmacy Association and medicines safety officer for independent pharmacies in England

DOACs account for 'notable number' of medication errors

By

A “notable number” of medication errors involving direct oral anticoagulants occurred in the first quarter of 2019, according to the National Pharmacy Association’s Medication Safety Officer update for April–June 2019.

Aspirin tablets close up

Aspirin increases bleeding risk in patients receiving warfarinSubscription

Compared with patients taking warfarin monotherapy, those taking aspirin and warfarin were at a higher risk of a bleeding event but the rate of thrombotic events was similar.

Busy hospital waiting room

Pharmacists should manage medicines during transitions of care to improve medicines safety, NHS Improvement proposes

A nominated pharmacist should be designated to manage medicines during patient transitions between all settings, NHS Improvement has proposed as part of a consultation on medicines safety.

woman with dementia ss 18

People with dementia less likely to receive oral anticoagulants despite stroke riskSubscription

People with atrial fibrillation who have dementia are less likely to receive oral anticoagulants (OACs) than those without cognitive impairment, research has shown.

Apixaban molecular structure

Direct oral anticoagulants carry lower risk of major bleeding versus warfarin, data showSubscription

Research from primary care suggests apixaban may be the safest of the direct oral anticoagulants overall.

Output of an electrocardiogram

Anticoagulant prescribing for AF patients with high stroke risk more than doubles

By

GP prescribing of anticoagulants for the treatment of patients with atrial fibrillation and a high risk of stroke more than doubled between 2000 and 2016, from 35.4% to 75.5%, according to research published in July 2018.

Human blood clotting light micrograph

Andexanet shows promise in patients taking new anticoagulants Subscription

Results from an ongoing trial of 228 patients with acute major bleeding show that patients taking andexanet experienced a reduction in anti-FXa activity.

Cross section of micrograph kidney

Uncertainty over anticoagulation risks and benefits in CKD patients with AF Subscription

The risk of both stroke and haemorrhage increases as chronic kidney disease progresses, which can complicate the decision on whether to begin anticoagulation in those with concomitant atrial fibrillation.

Warfarin anticoagulation monitoring in a pharmacy

Pharmacy-run anticoagulation service delivers 'enhanced clinical outcomes'

By Kathy Oxtoby

Community pharmacy is “ideally placed” to provide a safe anticoagulation service for patients needing warfarin monitoring

Warfarin tablet

Warfarin use associated with lower incidence of cancer in people aged 50 or olderSubscription

A Norwegian cohort study finds that warfarin has broad anticancer potential, which could have implications for medication choice for patients needing anticoagulation

Coloured angiograms (X-rays) taken from the front (left) and side (right) of a leg showing deep vein thrombosis in the calf

Pharmacomechanical therapy does not lower long-term risks in DVTSubscription

A study in The New England Journal of Medicine has shown no significant difference in results following pharmacomechanical therapy for deep-vein thrombosis

Urine test dipstick

Antithrombotic agents associated with haematuriaSubscription

Antithrombotic medications increase risk of complications linked to blood in the urine

Person takes INR pin-prick blood test

Genotype-guided warfarin dosing could improve safetySubscription

Patients receiving genotype-guided dosing of warfarin were less likely to have a major bleed or die than patients whose dosing was clinically guided.

warfarin blood thinner for atrial fibrillation

Anticoagulants could cut the risk of dementia for patients with atrial fibrillation, researchers find

Oral anticoagulants are associated with a significant reduction in the risk of dementia in patients with atrial fibrillation (AF), according to a study published in the European Heart Journal.

deep-vein-thrombosis-dvt-in-leg

Newer anticoagulants have no more safety risks than warfarin

Treating venous thromboembolism with direct oral anticoagulants creates no greater risk of major bleeding or death in the first 90 days of treatment compared with warfarin.

anticoagulation monitoring ss sept 17

RPS endorses community pharmacy oral anticoagulant safety audit

A new community pharmacy oral anticoagulant safety audit, developed by the NHS’s Specialist Pharmacy Service (SPS), has been endorsed by the Royal Pharmaceutical Society.

3D structure of the anticoagulant, dabigatran

Idarucizumab rapidly reverses dabigatran anticoagulationSubscription

Researchers find that idarucizumab effectively counteracts the workings of anticoagulant dabigatran in emergency situations.

anticoagulation monitoring of older patient

Row breaks out on whether GP practices should be funded for warfarin monitoring

By

Cash-strapped clinical commissioning groups (CCGs) are increasingly pushing GP practices to prescribe and monitor specialist drugs that are outside their area of expertise, without paying for the extra work. 

warfarin tablets anticoagulation treatment for atrial fibrillation

Delaying anticoagulation treatment for atrial fibrillation increases dementia risk, study suggests

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Results reinforce the importance of starting anticoagulation treatment as soon as possible after diagnosis, researchers conclude.

MRI scan showing intracranial haemorrhage

Intracranial haemorrhage risk of warfarin unrelated to INR controlSubscription

Study results show that choosing apixaban over warfarin could reduce the risk of anticoagulation-related intracranial haemorrhage.

Xray of a femur with a fracture from osteoporosis

Dagibatran carries reduced fracture risk compared with warfarinSubscription

Among patients with nonvalvular atrial fibrillation, study data show the use of dabigatran rather than warfarin was associated with a lower risk of osteoporotic fracture.

Screen shot of the warfarin dosing web application

Genotype-guided dosing improves safety of warfarin Subscription

Older adults who received a genotype-guided dose of warfarin via a web application were less likely to experience adverse effects compared with clinical dosing, trial results show.

Electrocardiogram machine

Atrial fibrillation patients not receiving guideline-recommended drugs to reduce stroke riskSubscription

Retrospective data analysis results show that the 16% of patients who were given anticoagulant prior to stroke showed reduction in stroke severity, lower odds of mortality and better functional outcomes.

Rivaroxaban, marketed by Xarelto

Rivaroxaban more effective than aspirin for preventing blood clots, study results suggest

By

Rivaroxaban is as safe as aspirin and more effective at preventing recurrent venous thromboembolism (VTE) in patients who were in equipoise for continued anticoagulants, a study shows.

warfarin tablets haematoma risk

Danish study confirms brain haemorrhage risk associated with anticoagulation

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Patients prescribed antithrombotic drugs, such as low-dose aspirin, clopidogrel or warfarin, are at increased risk of having a subdural haematoma, research published in JAMA has confirmed.

The new oral anticoagulant drugs Dabigatran, Rivaroxaban and Apixaban pills and pill boxes

Safety issues highlighted with newer oral anticoagulant drugs

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Analysis of ‘real-life’ data comparing newer direct oral anticoagulants with warfarin has identified adverse drug reactions (ADRs) ‘not previously associated’ with the new treatments, including hip fracture.

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