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Hart Insights: The Need for Change in Anticoagulation Care

By Hart Biologicals | 19th January 2021

Anticoagulation care in the UK

Anticoagulation care is a vitally important part of the UK health service. People at risk of strokes and heart attacks need to have the right care in place to help treat and prevent blood clots with targeted use of anti-coagulation medicines.

This is a major health issue in the UK, where figures show that there are 152,000 strokes in the UK each year.(1) This represents the fourth largest single cause of death in the UK and second in the world.(1) There are also 1.2m stroke survivors in the UK, who may require ongoing care and support.(1) This imposes a significant financial burden on the NHS, costing the health service an estimated £3 billion a year.(2)

There are various anticoagulation treatments available to support patients with blood clotting issues, including warfarin, non-vitamin K antagonist oral anti-coagulants (DOACs or NOACs) and injectable anti-coagulants. However, it is important to recognise that anticoagulation medication must be monitored.

INR monitoring

One of Hart Biologicals’ key areas of expertise is INR monitoring, which is the regular blood testing of patients on warfarin, to ensure dosage compliance and to inform appropriate adjustments.

While advances in technology have enabled the development of hand-held monitors to determine a patient’s warfarin dosage, such devices are far more expensive long-term than clinic-based equipment such as Hart Biologicals MC1, Thrombi-Stat

Health service commissioners at a CCG level must take a broad view when procuring medical equipment that considers the long-term cost savings and efficiencies, rather than the narrow, short-term benefits. 

It costs healthcare providers less than 50p per test using our wet chemistry method. This is a major saving compared to alternatives, such as dry chemistry strip testing, which costs £2-3 per use. Our products and reagents can also be used at GP surgeries, pharmacies, and community clinics, reducing pressure on secondary care services. In addition to this, there are several procedural issues in the NHS anticoagulation services that require attention.

Issues in the health service

While anticoagulation services are vitally important to uphold patient care standards and prevent adverse consequences of non-compliance, there is evidence to suggest NHS Trusts are not recording and monitoring this data effectively. Research by Thrombosis UK indicates that 42% of NHS Trusts do not routinely collect data on the time in therapeutic range (TTR) and the international normalised ratio (INR).(3)

This means they are potentially unaware of the number of patients in their care who are at increased risk of strokes or bleeding.(3) There is also a lack of procedural clarity. 62% of NHS Trusts have no written clinical protocols in place for reassessing anticoagulation with patients who have poor anticoagulation control.(4)

The provision of explanatory information about anticoagulation medicines is limited. An audit completed by Anticoagulation UK in 2018 found significant variations across NHS Trusts in the range and quality of information, education and support materials provided for atrial fibrillation (AF) patients to support their understanding of the condition and treatment.(3) Only 38% of the NHS Trusts providing support indicated that they provided leaflets or patient information booklets, with some directing patients to the websites of recognised patient groups.(3)

The procedural changes needed

We support the recommendation, that clinical guidelines, such as NICE, should be updated to include a clear specification of the information, education and support materials that anticoagulation service providers should be routinely offering to AF patients.(3) NICE guidelines for anticoagulation services should be updated to ensure hospitals have clear protocols in place for reassessing patients with anticoagulation issues. There should also be a requirement for NHS England to publish official INR and TTR data for anticoagulation services; this information could subsequently be shared with health commissioners at CCGs to improve their practices.

Greater provision should also be made for anticoagulation patient aftercare in the form of patient information leaflets, in line with official CQUIN requirements. At a time when the NHS is rethinking the future delivery of healthcare services as part of the Restart Agenda, changes must be made to improve anticoagulation services.

 

References

  1. Stroke Association State of the Nation Stroke statistics January 2016  Available online at: https://www.stroke.org.uk/sites/default/files/stroke_statistics_2015.pdf
  2. NHS England: Significant improvements in NHS stroke care, new study finds. November 2017 Available online at: https://www.england.nhs.uk/2017/11/significant-improvements-in-nhs-stroke-care-new-study-finds/#:~:text=Stroke%20is%20a%20devastating%20disease,productivity%2C%20disability%20and%20informal%20care.
  3. Anticoagulation UK Out of range: Audit of anticoagulation management in secondary care in England. April 2018. Available online at: https://thrombosisuk.org/downloads/2018%20Anticoagulation%20UK%20-%20Audit%20of%20Anticoagulation%20management%20in%20secondary%20care%20in%20England.pdf
  4. BJC Article: In brief. Br J Cardiol 2018;25:53. Available online at: https://bjcardio.co.uk/2018/06/in-brief-38/
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