Inappropriate Anti-coagulation of Patients with a Mechanical Heart Valve
Cegedim Healthcare Solutions has been made aware of a National Patient Safety Alert that has been issued on the risk of inappropriate anticoagulation of patients with a mechanical heart valve.
All patients with prosthetic mechanical heart valves require life-long oral anticoagulation with a vitamin K antagonist (VKA), usually warfarin, as these valves predispose the patient to systemic embolism.
Early in the Covid-19 pandemic, published guidance supported clinical teams to review patients treated with a VKA and where appropriate change their medication to an alternative anticoagulant (e.g. a low molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC)). This was partly to reduce the frequency of clinic attendance for monitoring, and thus reduce the risk to patients. The guidance listed exceptions where specific patients should not be switched from a VKA, including patients with a mechanical heart valve.
However, incidents have been reported of patients with a mechanical heart valve being switched to a LMWH or a DOAC.
Consequently, GPs and other NHS providers of anticoagulation services are being asked to identify any patients who have a record of a mechanical heart valve and are receiving a DOAC, and to urgently review these patients to ensure they are on the most appropriate anticoagulation therapy and monitoring.
Vision are advising GP practices to review such patients for the appropriateness of their treatment plans in mitigation of the risk that a patient may have had DOAC medication initiated inappropriately.
An audit has been made available in Vision+ for use to identify relevant patients. The name of the pathway is “Mechanical Heart Valve Anticoagulation (NPSA 2021-006)” and the reporting lines are as follows:
This audit will be helpful where a practice wishes to undertake a review of patients with a mechanical heart valve, and consider if any adjustments to anticoagulation therapy and / or monitoring are required.
Note that the purpose of the inclusion of the reporting line ‘Patients with codes indicating non-mechanical valves’ is to enable practices to check that such patients are correctly coded.