References

Curtis HJ, MacKenna B, Walker AJ. OpenSAFELY: impact of national guidance on switching anticoagulant therapy during COVID-19 pandemic. Open Heart. 2021; 8 https://doi.org/10.1136/openhrt-2021-001784

Medicines and Healthcare products Regulatory Agency. Warfarin and other anticoagulants—monitoring of patients during the COVID-19 pandemic. 2020a. https://tinyurl.com/y9b5dm9y (accessed 10 March 2022)

Medicines and Healthcare products Regulatory Agency. Warfarin and other blood thinners—reminder on safe use during COVID-19 pandemic. 2020b. https://tinyurl.com/2p8mtm6d (accessed 10 March 2022)

NHS England. Clinical guide for the management of anticoagulant services during the coronavirus pandemic. 2020. https://tinyurl.com/csnut58x (accessed 10 March 2022)

Pharmaceutical Journal. Patients taking anticoagulants feel excluded from therapy decisions. 2020. https://pharmaceutical-journal.com/article/news/patients-taking-anticoagulants-feel-excluded-from-therapy-decisions (accessed 10 March 2022)

How COVID-19 turned anticoagulation on its head. 2021. https://tinyurl.com/yea48akk (accessed 10 March 2022)

Salmasi S, Kapanen AI, Kwan L Atrial fibrillation patients' experiences and perspectives of anticoagulation therapy changes. Res Social Adm Pharm. 2020; https://doi.org/10.1016/j.sapharm.2020.01.004

Changes to anticoagulation during the pandemic

02 April 2022
3 min read
Volume 27 · Issue 4

In March 2020, as COVID-19 was declared a pandemic and efforts were made to reduce face-to-face consultations with patients, NHS England (2020) devised a rapid plan to switch patients who had previously had a blood clot and were on warfarin therapy to a direct oral anticoagulant (DOAC).

The goal of warfarin—a vitamin K antagonist and the most widely prescribed anticoagulant therapy—is to prevent blood clotting. It does this by delivering the lowest effective dose of anticoagulant to maintain the target international normalised ratio (INR). This measures how long it takes a person's blood to clot. Warfarin thins the blood to prevent blood clots, but not so much that bleeding risk increases. Trying to get this delicate balance right requires regular INR monitoring—a tall order for overextended healthcare resources during a pandemic.

Like most decisions made during the COVID-19 pandemic, the decision to switch as many patients on warfarin therapy as possible to a DOAC to reduce INR blood testing frequency while still keeping patients safe, was made quickly. It made sense, but without the time to consider all aspects or potential consequences, it was not without its challenges. There were many aspects to be weighed and considered in switching patients' anticoagulant therapy.

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