Historically, warfarin was the anticoagulant of choice for the management of non-valvular atrial fibrillation (NVAF). Direct-Acting Oral Anticoagulants (DOACs) have now emerged as the preferred option for treating AF, as recommended within the National Institute for Health and Care Excellence (NICE) clinical guideline 196, Atrial fibrillation: diagnosis and management.
The 2022/23 Network Contract Directed Enhanced Service (DES) specification included an indicator (CVD-05) aimed at improving the appropriate prescribing of anticoagulation for people with AF. This indicator was aligned with NICE CG 196 and places DOACs as the first line option. The DES goes further to incentivise the use of edoxaban as the DOAC of choice where clinically appropriate (indicator CVD-06).
Concern was raised across the local system about the risks associated with switching between different anticoagulants. To support Primary Care Network (PCN) clinicians who may be considering undertaking DOAC switch optimisation, in line with CVD-06, a single switch protocol and FAQs document were developed in collaboration, across 6 systems in the West Midlands Region.
The main scope of the project was to support safe review and switching of anticoagulant medication in clinically appropriate patients following a holistic review, taking into account all appropriate clinical considerations, including monitoring.
The main outcomes/impacts of this project included:
• Promoting a robust process to reduce risk of harm to patients from inappropriate switching
• Reducing duplication of work and more efficient use of resources across the systems
• Production of a single document , which was adopted across all local systems
• Encouraging engagement and communication with patients as part of the shared decision-making process
• Promoting cost effective DOAC use, where clinically appropriate
• Successful collaboration across the systems
• Use of modern technology to streamline collaborative working approach
