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Warfarin monitoring

Checked: 23-01-2023 by Vicky Ryan Next Review: 23-01-2024

Anticoagulation Clinic - NBT

New Referrals to NBT Anticoagulation Monitoring Service - use the Anticoagulation Monitoring Service (AMS) referral form which should be completed in full and emailed to ams@nbt.nhs.uk.

If consultant face to face opinion is required refer to Haematology via e-RS or Haematology A+G (if just advice)

Patients managed by DAWN (NBT Anticoagulation Service - AMS) attend the surgery with a yellow blood request form. This form identifies them as DAWN patients and samples are ‘coded’ appropriately for Anticoag attention.

If patients forget their yellow form, the INR is often requested via ICE as ‘warfarin monitoring’ – in this case the sample will be analysed and the results appear on ICE, but the DAWN system is unaware of the sample taken so the patient does not receive any dosing advice. This has occasionally led to poor management of the anticoagulation.

In order to improve the simplicity of requesting DAWN dosing without a yellow slip, a new tab has been added to the ICE requesting system:

Tick the ‘Anticoag – DAWN dosing’ and the box below will appear which has questions (which mirror those on the yellow form) for the clinician to answer.

Any free text that you add to the above box will appear on the pathology interface.

If the requestor is unable to use ICE and the patient has no YELLOW FORM, use the Anticoagulation Monitoring Service (AMS) referral form and ensure that the requests is annotated for AMS Monitoring and that the patients weight is included. Please note this form goes to AMS@nbt.nhs.uk

Please do not routinely book INRs in the afternoon – we cannot dose the same day and this could adversely affect the patients

Some patients work and evening INRs might be the only time that they can attend – this should be the exception rather than the rule.

Anticoagulation monitoring

DAWN desk Telephone: 0117 4148405 for patients.

HCP only Tel: 07718 575 471 (0900-1700)

Anticoagulation Clinic - UHBW

The UHBW Warfarin service monitors INRs and advises warfarin doses for patients registered with GP surgeries that send bloods to the BRI lab.

Please use the referral form to refer patients to UHBW for warfarin monitoring.

The other vitamin K antagonists, acenocoumarol and phenindione, are also monitored - specify on the referral form.

Patients attend the GP surgery for INR tests. INR results are reviewed and warfarin doses advised by the anticoagulation pharmacy team. INR result, warfarin dose and next advised INR date are posted to the patient; patients are telephoned if necessary.

Outpatient appointments with an anticoagulation pharmacist for warfarin counselling are offered to patients being initiated on warfarin, or that have started warfarin recently.

Send completed referral forms to: warfarin.helpline@uhbw.nhs.uk

Tel:0117 342 3874 This is the anticoagulation pharmacist warfarin helpline available to patients and healthcare professionals from 9am – 1pm and 2pm – 5pm, Monday to Friday

Subtherapeutic INR

Please see the link to Formulary page - Cardiovascular System Guidelines (Remedy BNSSG ICB) to find the guideline document on Management of Subtherapeutic INRs in the Community (listed under Anticoagulation Guidance).

High INR

Please see the link to Formulary page - Cardiovascular System Guidelines (Remedy BNSSG ICB) to find the guideline document on Management of High INRs in the Community (listed under Anticoagulation Guidance).

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.