This website is intended for UK healthcare professionals only

The development and hosting of this resource centre has been commissioned by Roche Diagnostics Limited (Roche). This resource centre contains links to Guidelines and Guidelines in Practice independent educational content, clinical resources, and additional items from Roche, some of which may be promotional in nature.

Best practice in
ANTICOAGULATION

 
  Tab Menu
Introduction
NICE quality standards
and related tools
Stroke prevention in people with atrial fibrillation
People with prosthetic heart valves
Venous thromboembolism
Tools and case studies
Financial impact
Information to use with patients
 

Welcome to the Guidelines Resource Centre: Best Practice in Anticoagulation

Aims of this resource centre

Anticoagulation treatment is a crucial intervention for a number of patient groups such as people with atrial fibrillation (AF), venous thromboembolism (VTE), genetic clotting disorders, and those who have had a stroke or who have artificial heart valves. 

It is important that people receiving anticoagulants are informed about their condition and treatment, and receive appropriate monitoring.

This resource centre aims to support you in:

  • keeping up to date with best practice in the management of patients receiving anticoagulation treatment
  • learning about current guidance on anticoagulation and how to implement it
  • learning from how others have implemented initiatives relating to anticoagulation treatment
  • gaining CPD credits for revalidation
  • provision of patient education. 

We hope that you will find this resource centre informative and useful.

From the Guidelines team

Type of content

You will find information on venous thromboembolism (VTE), stroke prevention in people with atrial fibrillation (AF), and stroke prevention in people with prosthetic heart valves by clicking on the relevant tab in the menu bar. The resource centre includes:

  • Guidelines summaries on the management of patients with AF and VTE
  • expert Guidelines in Practice articles on the implementation of relevant clinical guidance
  • an eLearning module, management algorithm, implementation checklist, and a webinar 
  • case studies
  • supporting information to use with patients
  • training resources.

How the content was developed

On this website, we also clearly state if the content has been:

  • developed independently by MGP
  • developed by MGP in partnership with Roche 
  • provided by Roche.

NICE quality standards  

NICE has published quality standards on atrial fibrillation and venous thromboembolism that define best practice within these clinical areas. Each quality standard provides specific, concise quality statements, measures and audience descriptors to provide definitions of high-quality care.

NICE has also developed tools and resources for each quality standard to help put them into practice.

Atrial fibrillation

The new NICE Quality Standard 93 covers the identification, treatment, and management of atrial fibrillation (including paroxysmal, persistent and permanent atrial fibrillation, and atrial flutter) in adults (18 years and older):

Click here to access the following resources for NICE Quality Standard 93:

  • Guidance into practice—gives practical advice on how to use NICE guidance and related quality standards to achieve high-quality care
  • Implementation resources for Clinical Guideline 180 and Diagnostic Guidance 14—include a costing report and template, implementation advice, tailored education support, and information on health technology adoption support
  • Quality standard service improvement template—enables providers to assess how their service compares with the quality standard statements.

Venous thromboembolism 

NICE Quality Standard 3 covers the reduction in risk of venous thromboembolism in adults admitted as hospital inpatients or formally admitted to a hospital bed for day-case procedures:

Click here to access the following resources for NICE Quality Standard 3:


  • Audit support—can be used to measure current practice in reducing the risk of venous thromboembolism against NICE guidance
  • Commissioning guide and budgeting tool—can be used to estimate and inform the level of service needed locally and the cost of commissioning decisions
  • Guidance into practice—gives practical advice on how to use NICE guidance and related quality standards to achieve high-quality care
  • Shared learning—collates examples of areas that improved care by implementing the quality standard
  • Slide set—are aimed at supporting healthcare professionals to raise awareness of venous thromboembolism
  • Support for commissioning—reviews the potential cost impact and implications for commissioners and service providers of the NICE quality standard 
  • Quality standard service improvement template—enables providers to assess how their service compares with the quality standard statements.

NICE Quality Standard 29 covers the diagnosis and treatment of venous thromboembolic diseases in adults, excluding pregnant women:

Click here to access the following resources for NICE Quality Standard 29:


  • Clinical case scenarios—provide case examples of deep vein thrombosis and pulmonary embolism in a question and answer format that individuals and groups can work through
  • Commissioning guide—supports commissioners to review how anticoagulation therapy is currently initiated, provided, monitored and reviewed in their local area 
  • Guidance into practice—gives practical advice on how to use NICE guidance and related quality standards to achieve high-quality care
  • Implementation advice—supports implementation of Clinical Guideline 144 and Technology Appraisal 261
  • Support for commissioning—considers the cost of achieving the quality standard at a local level, identifies where potential cost savings can be made, and highlights areas of care in the quality standard that have potential implications for commissioners
  • Tailored education support —provides templates for using the two-level Wells score
  • Quality standard service improvement template—enables providers to assess how their service compares with the quality standard statements. 

Guidelines in Practice checklist

The checklist reproduces the quality statements from NICE Quality Standard 93 on atrial fibrillation and summarises key recommendations from NICE Clinical Guideline 180 and NICE Diagnostics Guidance 14.

Guidelines in Practice approached Roche Diagnostics Ltd to fund the printing costs for this summary sheet. Roche Diagnostics Ltd was not involved in the development of this sheet although it was allowed to review it for technical accuracy. At all times editorial control has remained with Guidelines in Practice. 

Stroke prevention in people with atrial fibrillation

Guidelines algorithm 

The algorithm includes text on why self-monitoring for warfarin therapy may be beneficial, criteria for identifying patients who are suitable for self-monitoring therapy, when to review patients, and information on patient education.

The development of this management algorithm has been funded by an educational grant from Roche Diagnostics Ltd. Roche Diagnostics Ltd reviewed the scope and background reading list, and suggested the participants of the algorithm development group. Roche Diagnostics Ltd had the opportunity to comment on the medical content and accuracy of this management algorithm, however, final editorial control has remained with the contributors and Guidelines. The views and opinions of the contributors expressed in this document are not necessarily those of Roche Diagnostics Ltd, or of Guidelines, its publisher, advisers, or advertisers.

Guidelines in Practice checklist

The checklist reproduces the quality statements from NICE Quality Standard 93 on atrial fibrillation and summarises key recommendations from NICE Clinical Guideline 180 and NICE Diagnostics Guidance 14.

Guidelines in Practice approached Roche Diagnostics Ltd to fund the printing costs for this summary sheet. Roche Diagnostics Ltd was not involved in the development of this sheet although it was allowed to review it for technical accuracy. At all times editorial control has remained with Guidelines in Practice.

Guidelines eLearning module

The eLearning module will be useful to all primary healthcare professionals who encounter adult patients with atrial fibrillation who are or may be at risk of stroke, and who might benefit from introduction of self-monitoring of their anticoagulation status. 

This eLearning module has been funded by Roche Diagnostics Ltd and developed in partnership with Guidelines.co.uk. Roche Diagnostics Ltd suggested the author for the module and reviewed the module to ensure compliance with appropriate regulations.

Guidelines in Practice webinar 

The webinar will help healthcare professionals:

  • gain an understanding of NICE QS93 and Diagnostic Guidance 14
  • achieve a perspective on how the guidance should be implemented and incorporated into treatment plans   
  • learn how to perform, analyse, and assess factors involved in anticoagulation control, and become informed on the use of a coagulometer
  • understand the implications for patients.

This webinar has been commissioned by Roche Diagnostics Ltd and organised in partnership with Guidelines in Practice. Roche Diagnostics Ltd has reviewed the scope of the workshop, worked with MGP Ltd to choose and commission speakers, and approved all materials related to the webinar. MGP Ltd has paid the honoraria to the speakers on behalf of Roche Diagnostics Ltd. The views and opinions of the speakers are not necessarily those of Roche Diagnostics Ltd or of MGP Ltd, Guidelines in Practice, its publisher, advisers, or advertisers.

Diagnostic Guidance supplement 

 

The production and printing of this Diagnostic Guidance supplement has been funded by Roche Diagnostics. Roche Diagnostics has reviewed this supplement for technical accuracy and regulatory compliance.


Guidelines summaries

Guidelines in Practice articles

  • Novel anticoagulants bring stroke prevention therapy to more people
    Authored by: 
    • Dr Stavros Apostolakis, University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Birmingham and Professor Paulus Kirchhof, University of Birmingham Centre for Cardiovascular Sciences and SWBH NHS Trust, Birmingham; Department of Cardiovascular Medicine, University of Münster, AFNET e.V., Münster Germany
    Published online: January 2014

NICE quality standard

People with prosthetic heart valves

Diagnostic Guidance supplement

This supplement reproduces the NICE recommendations from NICE Diagnostics Guidance 14.

The production and printing of this Diagnostic Guidance supplement has been funded by Roche Diagnostics. Roche Diagnostics has reviewed this supplement for technical accuracy and regulatory compliance.


Lancet publication

An analysis by Heneghan C et al (Oxford University) showed that self-monitoring and self-management of oral coagulation is a safe option for suitable patients of all ages. 

Venous thromboembolism

Guidelines summary

Guidelines in Practice articles

  • NICE VTE pathway is blueprint for reducing death and disability
    Authored by:
    • Dr Anil Kamat, Consultant Haematologist, Darent Valley Hospital, Dartford
    Published online: February 2015
  • NICE quality standard brings management of VTE system-wide
    Authored by:
    • Dr Alex Coupland—Teaching Fellow, Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne
    • Dr Gavin Flatt—Technical Analyst for Quality Standards and Indicators, Directorate of Health and Social Care, NICE
    • Professor Gerard Stansby—Professor of Vascular Surgery, Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne
    Published online: July 2013
  • The two-level Wells scores should be used in suspected VTE cases 
    Authored by: 
    • Adriano Sala Tenna—Specialty Trainee, Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne
    • Scott Harrison—Lead Pharmacist (Anticoagulation), Oxford University Hospitals NHS Trust, Oxford
    • Liz Avital—Associate Director, National Clinical Guidelines Centre, Royal College of Physicians, London
    • Gerard Stansby—Professor of Vascular Surgery, Northern Vascular Centre, Freeman Hospital, Newcastle-upon-Tyne
    Published online: September 2012

NICE quality standards


Case studies     

The case studies outline local initiatives that have incorporated point of care testing for D-dimer into general practice and the community:

Tools and case studies

The following resources, some of which may be promotional in nature, were provided by Roche Diagnostics Limited.

Tools

Patients on long-term vitamin K antagonist therapy require regular monitoring and healthcare professionals should regularly review the ability of patients and carers to use their self-monitoring devices effectively.


NICE recommends self-monitoring of coagulation status in adults and children on long-term vitamin K antagonist therapy who have atrial fibrillation or heart valve disease if people prefer this form of testing and if the person or their carer is both physically and cognitively able to self-monitoring effectively. 

 

The pack covers several key areas that will provide healthcare professionals and their organisation with information on building a business case and operational plan to implement a self-monitoring service.


CoaguChek XS Handling videos:

The videos can be used by healthcare professionals to support the management of patients who are receiving warfarin. They provide information and advice on how to use CoaguChek devices correctly.


 

CoaguChek XS Plus Handling videos:
CoaguChek XS Pro Handling videos:

Case studies

The case studies outline local initiatives that have transitioned from laboratory testing to a near patient testing service for warfarin management. They cover aspects such as patient experience and clinical practice, and outlined the resulting outcomes, including improved control of international normalised ratio and patient empowerment.


Financial impact

NICE has developed a number of tools and resources relating to the financial implications of implementing its guidance on anticoagulation treatment.

Clinical Guideline 180 on Atrial fibrillation: management

NICE has developed:

Diagnostics Guidance 14 on Atrial fibrillation and heart valve disease: self-monitoring coagulation status using point-of-care coagulometers (the CoaguChek XS system and the INRatio2 PT/INR monitor)

NICE has developed:

Clinical Guideline 144 on Venous thromboembolic diseases: diagnosis, management and thrombophilia testing

NICE has developed:

The following resources, some of which may be promotional in nature, were provided by Roche Diagnostics Limited.
Patient website

Patients can obtain information about self-monitoring, using CoaguChek, and ask for advice and support

SelfieChek

Patients wishing to learn more can visit SelfieChek, which is an online community for people on long-term warfarin. SelfieChek asks people who self-test to share their experiences on the page and raise awareness of self-testing as an option. SelfieChek offers the opportunity to learn more about self-testing from other patients and can be found here.

Nutrition

Healthcare professionals should give advice to patients receiving warfarin therapy on eating a consistent, healthy diet as the international normalised ratio level can be affected by what patients eat and drink

Travel 

This leaflet provides information on what patients receiving warfarin therapy should discuss with their doctor before travelling, and advice on where to storing items relating to therapy while travelling. 

Patient testimonials and device handling support

Patient testimonials: Diane's story
Patient testimonials: Katherine's story
Patient testimonials: Roy's story


The guide and the videos demonstrate how to use CoaguChek devices


CoaguChek XS Handling videos:

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