Making sense of anticoagulants for GPs: New NPS MedicineWise program
A new educational program for health professionals by NPS MedicineWise will help provide clarity around the newer anticoagulants and put them into context with warfarin, an anticoagulant that has been the mainstay of clinical practice for many years. The program – Achieving Good Anticoagulant Practice – launches on 5 February 2013.
NPS MedicineWise clinical adviser Dr Danielle Stowasser says that the program will assist GPs to feel more confident in their clinical-decision making when it comes to prescribing and monitoring patients requiring anticoagulant therapy.
The latest edition of Medicinewise News, ‘Good anticoagulant practice’, distributed to over 70,000 health professionals from 5 February, looks at optimising treatment with warfarin as well as whether and when to consider switching patients from warfarin to a newer anticoagulant.
“This latest edition of Medicinewise News outlines why people with non-valvular atrial fibrillation (AF) whose anticoagulation is well controlled using warfarin may not benefit clinically from switching to a newer oral anticoagulant,” says Dr Stowasser.
“Importantly, it also reminds prescribers that although there are no readily available and validated tests for measuring the activity of the newer oral anticoagulants, routine clinical monitoring of all patients on anticoagulant therapy is still essential, regardless of which type of anticoagulant they are using.
“In other words, newer oral anticoagulants may not need monitoring via a blood test, but the people taking them certainly still do, particularly as there is currently no readily available antidote for reversing these medicines’ effect.”
Medicinewise News covers starting treatment with anticoagulants, treatment of non-valvular AF based on stroke risk, the newer anticoagulants and their place in therapy, issues around switching, the importance of ongoing monitoring in people taking oral anticoagulants, and a decision tool to assist with starting oral anticoagulants.It also contains a ready reference chart outlining the steps for warfarin best practice and for achieving and maintaining INR in the therapeutic range.
“It’s estimated that as many as 90% of patients who present with AF-related strokes have received inadequate anticoagulation therapy, and 60% of patients are not receiving any anticoagulants at the time of their stroke,” says Dr Stowasser.
“We know that people with non-valvular AF do not receive adequate stroke prevention treatment even when assessment of their risk indicates that anticoagulation is required.
“This discrepancy between the need for anticoagulation and the evidence for under-treatment represents one of the major evidence–practice gaps in medicine today. The new NPS program aims to address some GP uncertainties that may be contributing, such as fears about bleeding risks.”
NPS facilitators will begin delivering face to face educational visits on the Achieving Good Anticoagulant Practice program for GPs and pharmacists from February. Educational visits are free and attract CPD points, and can be booked by contacting the NPS facilitator at your Medicare Local or contacting NPS directly.
“The availability of newer oral anticoagulants provides a great opportunity for GPs to review treatment for patients at risk of thromboembolism and assess whether current warfarin management could be improved,” says Dr Stowasser.
“It is our goal that the new program will cut through the confusion and provide reassurance and accurate, evidence-based information about using anticoagulants safely and effectively.”
For more information about the new program, resources and regular program updates visit www.nps.org.au/anticoagulants
Independent, evidence-based and not-for-profit, NPS MedicineWise enables better decisions about medicines and medical tests. We are funded by the Australian Government Department of Health and Ageing.
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