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Anticoagulation in Practice 2011 - conference report
The Fifth Scientific Meeting of The Primary Care Cardiovascular Society - Anticoagulation
2011 marked an important turning point for the 'Anticoagulation in Practice' conference; no longer the product of 4 special interest groups this was the first opportunity for the Primary Care Cardiovascular Society - Anticoagulation (a special interest group of the PCCS) to take the conference forward on its own.
Professor David Fitzmaurice welcomed 160 delegates including GP's, practice nurses, biomedical scientist, pharmacists and patients to the impressive Leonard Deacon lecture theatre in the Wolfson Centre of the Medical School, University of Birmingham.
Click here to view the full conference report
Presentations from the conference can still be viewed here...
Research Update
ExACT
There are a few people who, after having had a clot in the legs (DVT) or lungs (PE), are at very high risk of having another one. The ExACT study aims to identify those people at highest risk of having a second clot and to see if by giving warfarin treatment for longer it is possible to prevent the second clot happening. We are looking to identify those patients at highest risk of developing post thrombotic syndrome, which is a major cause of leg ulcers. We also hope that this study will provide us with sufficient information to determine the most cost-effective means of both preventing and treating clots.
Jayne Tullett - j.tullett@bham.ac.uk
ExPeKT - An exploration of current knowledge and barriers to VTE prevention
Little is known about the role of primary care in thromboprophylaxis and the information high risk patients receive prior to hospital admission or after discharge. The majority of VTE episodes occur days or weeks after a patient has been discharged from hospital. Primary healthcare professionals initially responsible for patient care often remain unaware that a patient has experienced an event. Coordinated care and the integrated management of thromboprophylaxis between hospital and the community are essential. This study will explore existing knowledge and the perceived role of primary care in thromboprophylaxis. Primary health care professionals, acute trusts and other relevant organisations will be recruited to take part in the study. In addition, patients will be surveyed regarding their attitudes to receiving thromboprophylaxis and their awareness, knowledge and experience of VTE risk and assessment at each stage of their engagement with VTE prevention.
For further information or if you would like to contribute to the study please contact:
Lorraine McFarland l.a.mcfarland@bham.ac.uk
A prospective, multi centre, international registry of male and female patients newly diagnosed with Atrial Fibrillation (AF) with at least one additional risk factor for stroke.
Atrial fibrillation (AF) is the most common clinically significant arrhythmia in the adult population, and a strong, independent risk factor for cerebrovascular accidents. Patients with non-valvular AF are 5 times more likely to suffer a stroke whilst patients with valvular AF see their risk increase about 17 fold.
The idea of this study is to construct a large registry of patients diagnosed with AF to identify current treatment patterns and their associated outcomes, which has never been previously investigated within a non-randomised selected population. The primary target population is patients with a new diagnosis of AF with at least one additional risk factor for stroke.
Thank you to all of those practices who have expressed an interest and attended the training for this study. We are still recruiting practices across the UK, so if you would like to be involved with this study, or would like further information, please contact one of the study team on:
Patricia Apenteng (Research Facilitator) – p.n.k.apenteng@bham.ac.uk
Ellen Murray (Senior Lecturer) - e.t.murray@bham.ac.uk
Jo Hine (Research Programme Administrator) - j.hine.1@bham.ac.uk
Anticoagulated patients and head injury
Anticoagulated patients are more vulnerable to intracerebral bleeding after head injury and more likely to die if an intra-cerebral bleed occurs. This is reflected by the specific advice for CT scanning after head injury in anticoagulated patients offered by NICE and SIGN guidance. Clinical guidance has to balance the risk of missing intracerebral injury with the risk that too low a threshold for CT scanning would disadvantage other patients.
To read more please click here
Cranberry Juice is Safe to Consume with Warfarin!
Jack Ansell, M.D.
There is no creditable scientific evidence to link an interaction between the moderate consumption of cranberry juice and warfarin.
In September 2003, the UK Committee on Safety of Medicines (CSM) issued a warning of a possible interaction between warfarin and cranberry juice. This warning was based on five spontaneous brief case descriptions (nothing more than a few sentences) suggesting such an interaction, leading to changes in INR values. The Committee indicated that the interaction is biologically plausible since cranberry juice contains various antioxidants, including flavonoids, which are known to inhibit specific cytochrome P450 enzymes. They acknowledged that further investigation was needed and recommended that until this matter was concluded, it would be prudent for patients taking warfarin to be advised to limit or avoid drinking cranberry juice. Similar warnings appeared on the labels for the FDA-approved products Coumadin® (warfarin, Bristol-Myers Squibb) and several generic warfarin products.
to read more on this article please click here
PSM Registry
As more people undertake self- monitoring or self management of their oral anticoagulation it is important to ensure that therapeutic control is maintained. An electronic central register could provide a valuable tool for studying the safety and effectiveness of this method of service delivery. This study will evaluate the feasibility of people who self monitor or self manage entering their data onto a website to produce such a register.
This study is now live; please click here for the website
For further information about this study please contact Jenny Baker here
Interactions Between Herbal Medicines and Prescribed Drugs
"The concomitant use of herbal medicines and pharmacotherapy is wide spread. We have reviewed the literature to determine the possible interactions bewteen seven popular herbal medicines (ginkgo, St John's wort, ginseng, garlic, echinacea, saw plametto and kava) an convential drugs."
Izzo AA, Ernst E.
Interactions between herbal medicines and prescribed drugs: an updated systematic review.
Drugs. 2009;69(13):1777-98
Diagnosis and managment of the antiphospholipid syndrome
"Antiphospholipid syndrome was first described 27 years ago in patients with systemic lupus erythematosus (SLE) and positive anticardiolipin antibodies, who presented with a clotting syndrome that affected arteries and veins. Female patients had a high risk of recurrent miscarriage and late fetal loss. The international classification criteria for this syndrome used today are based on those initial clinical observations."
Danielle Cohen, research fellow, Stefan P Berger, nephrologist, Gerda M Steup-Beekman, rheumatologist, internist, Kitty W M Bloemenkamp, maternal fetal medicine specialist, Ingeborg M Bajema, pathologist
Clinical Review - Diagnosis and management of the antiphospholipid syndrome
BMJ 2010;340:c2541
Practical management of coagulopathy associated with warfarin
"When choosing a management strategy for a patient who is being treated with a vitamin K antagonist and presents with an INR outside the therapeutic range, consider the risk of both bleeding and thrombosis"
RE:LY Dabigatran AF study concludes...
"In patients with atrial fibrillation, dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage. Dabigatran administered at a dose of 150 mg, as compared with warfarin, was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage."
National Pharmacy Association SOP for supplying
anticoagulant therapy
The NPA has produced a new standard operating procedure (SOP) for the supply of anticoagulant therapy. The document provides details of the National Patient Safety Agency (NPSA) patient alert “NPSA Alert 18 - Actions that can make Anticoagulant Therapy Safer”.
The SOP is freely available for download from the NPA website
Good news for hip and knee surgery patients
On March 18, 2008, the European Medicines Agency granted marketing authorisation for dabigatran. The National Health Service have authorised the use of Pradaxa (developed by pharmaceutical company Boehringer-Ingelheim) for use in preventing venous embolism in patients who have undergone orthopaedic surgery.
NOTE: This site is a source of information, links & references. It is NOT a helpline. Patients with questions regarding anticoagulant treatment, please contact your doctor.
If you would like to comment on the site or make suggestions on how the site could be improved please email us with your ideas.