NEW YORK (Reuters Health) -- The first six letters of the English alphabet form the basis of a new checklist for monitoring patients receiving direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation.
"The checklist was designed as a knowledge-translation tool to assist clinicians in providing best-practice follow-up care for patients receiving DOACs," Dr. David J. Gladstone, from Sunnybrook Health Sciences Centre, University of Toronto, Canada, told Reuters Health by email.
"The checklist distills hundreds of pages of published recommendations, product monographs, clinical trial results, and expert opinion into a practical point-of-care tool, a one-page worksheet that can be used by primary care physicians, specialists, nurses, and pharmacists whenever DOAC-treated patients are seen for follow-up visits," he said.
The DOAC Monitoring Checklist "was developed by a multidisciplinary group from clinicians interested in atrial fibrillation and anticoagulant management and refined through pilot-testing in outpatient clinics and by input from external reviewers," Dr. Gladstone explained. "The checklist reinforces and extends excellent recommendations published by the European Heart Rhythm Association in 2013."
The one-page tool, described by Dr. Gladstone and colleagues in their June 30 Annals of Internal Medicine online report, includes:
A: Adherence assessment and counseling
B: Bleeding risk assessment
C: Creatinine clearance (for dosing decisions)
D: Drug interaction assessment and counseling
E: Examination (with focus on blood pressure and fall risk)
F: Final assessment and follow-up
"Anticoagulant management should be viewed as a continuous quality assurance process that depends on a dynamic balance of multiple factors influencing benefit versus risk," Dr. Gladstone said. "Direct oral anticoagulants have safety advantages over warfarin, but still entail risk. Therefore, we advocate regularly scheduled, standardized clinical follow-up assessments and counseling to optimize benefit-risk in long-term DOAC therapy."
"Just because we don't have to monitor an INR (international normalized ratio) for these drugs doesn't mean we don't have to monitor the patient," he concluded.
"We encourage research to evaluate this type of practice tool," Dr. Gladstone said. "In the meantime, we hope the checklist will be a helpful tool to streamline patient assessments and assist clinicians in delivering best-practice follow-up care for patients receiving these drugs."
"Checklists like this, if used regularly, have the potential to improve patient outcomes, especially in light of recent studies demonstrating that adherence to DOAC therapy is frequently suboptimal, poor adherence correlates with increased stroke risk, and DOAC adherence can be significantly improved by a pharmacist-led patient monitoring intervention," he said.
"The DOAC Monitoring Checklist and accompanying quick-reference tables are available for free download at ," Dr. Gladstone added.
The authors reported no commercial funding.
SOURCE:
Ann Intern Med 2015.