Anticoagulation: not that straight forward!
Jerome Durodie spends a day at Hastings & Rother CCG
On 25th July Jerome Durodie was invited to spend a day with Hastings & Rother CCG talking to a wide group of healthcare professionals about the complexities of anticoagulation, notably around the use of warfarin and the fact that the evidence base behind the NOACs (novel oral anticoagulants) is still limited. He detailed that whilst it was important to understand ‘the science’ that much of what needs to be sorted with warfarin is actually ‘an art’, and that this can be disconcerting to healthcare professionals and patients alike. Jerome spent time discussing the pros and cons of the novel oral anticoagulants, putting them into an evidence based context, and making it clear that they are not ‘an easy, quick-fix replacement’ for warfarin, for either the prescribing clinician or the patient, despite much media attention. Discussion was had about the understanding of ‘non-inferiority’ studies, use of placebo control and the paucity of direct comparator studies. A strong message was conveyed about the absolute importance of consistency, both in terms of conveyed messages and of how patients adjust their behaviour when warfarinised; ‘thou shalt not ……. (because you’re on warfarin)’ being a perception that needs to be broken!
Jerome used a combination of case studies and data analysis to reinforce key messages and help attendees apply their knowledge to ‘real life’ situations. Attendees were challenged about how broad the whole issue of factors affecting INR (the test used to monitor warfarinisation) stability was (including diet in the widest possible way; ie. not just limited to vitamin K content).
The day ended on an unexpected discussion as to the basis of the INR Star software for use in practices when undertaking near patient testing (NPT).
Attendees were very positive in their feedback as to Jerome both as an academic pharmacist presenter and his enthusiasm of and competence in this topic.