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Covid-19 Primary Care Resources


Anticoagulation



Prescribing during the pandemic

This information is sourced from NHS England/ NHS Improvement, the Specialist Pharmacy Service and the Royal Pharmaceutical Society:

Anticoagulation

  • Review if long-term warfarin therapy is still indicated (eg prior DVT/PE with low risk of recurrence)
  • Consider suitability for treatment with a DOAC instead of warfarin
  • Not all patients are suitable for a switch to DOAC, and in some cases, specialist advice may be required
  • Consider prioritising patients on warfarin with poor control of INR for a switch to DOAC (as they need the most frequent INR checks)
  • If DOAC unsuitable consider LMWH (as last option as current LMWH supply issues)

Warfarin prescribing during the pandemic

  • Consider reducing the frequency of INR monitoring for stable patients on warfarin
  • Keep to a maximum of 12 weeks between INR checks
  • Consider if patients could be trained to self-test INR in their own homes if able to obtain a CoaguChek machine
  • NICE recommends self-testing of INR using CoaguChek meters for patients with prosthetic mechanical valves and for those with AF
  • As a last resort if INR testing is not possible and warfarin cannot be dosed safely, warfarin could be temporarily stopped after risk:benefit discussion with the patient; restart as soon as it is safe to do so
  • Patients with mechanical heart valves MUST stay on warfarin

Warfarin prescribing in patients unwell with Covid 19

  • For those who cancel their 12-week check due to symptoms of coronavirus, extend the interval to 14 weeks if safe to do so
  • Infection with COVID-19 is likely to have a detrimental effect on warfarin control

Patients being treated with DOACs in primary care

  • Telephone triage should be in place to support patients, eg for those experiencing bleeding symptoms in primary care
  • Renal monitoring should be undertaken at least annually, and more regularly in people with renal dysfunction, over the age of 75 years or who are frail
  • Specialist support for primary care prescribers should be available should issues arise during DOAC treatment

Guidance for the safe switching of warfarin to direct oral anticoagulants (DOACs) for patients with non-valvular AF and venous thromboembolism (DVT / PE) during the coronavirus pandemic is available from the Royal Pharmaceutical Society