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Audit

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by

Aanchal Kadam

on 4 October 2012

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Transcript of Audit

By Aanchal Kadam and Alexander Jeffrey An Audit on the Diagnoses of Patients on Warfarin Warfarin 127 patients at the practice have been on warfarin in the last 6 months.
Of these 127 patients 87 of them have confirmed diagnosis of Atrial Fibrillation.
Our aim was to look at the remaining 40 patients on warfarin and examine what their diagnosis is. Who is on Warfarin? The 40 remaining patients had a variety of other diagnoses

Recurrent Venous Thromboembolism (VTEs= DVTs + PEs) - 21
Heart Valve Replacements - 5
Atrial Fibrillation - 4
Cerebral Vascular Accident/ Transient ischaemic attack - 3
Antiphospholipid Syndrome - 2
Ischaemic Heart Disease - 3
Left Ventricular Thrombus - 1
Femoral Endarterectomy - 1 The Breakdown The Future of
Anticogaulation conclusion ` Warfarin Sodium
antagonizes the effect of vitamin K --> reduced hepatic production of coagulation factors II, VII, IX and X
increases INR and prothrombin time
Indications
Guidelines
dose : for rapid anticoagulation - 5-10 mg
dose : for maintenance - 3-9mg taken at the same time each day
tablets 500 microgram (white), 1mg (brown), 5mg (pink)
Haemorrhage
Interactions
Great Drug! In 1955, Warfarin was given to President Dwight Eisenhower following a myocardial infarction As Duxbury and Poller point out; ‘What was good for a war hero and the President of the United States must be good for all, despite being a rat poison!’ Antiphospholipid Syndrome Asplenia Ischaemic Heart Disease 36 year old lady
Stroke
secondary thrombocytosis

International Journal of Cardiology. 2012 Jun. "Thrombocytosis in asplenia syndrome with congenital heart disease: A previously unrecognized risk factor for thromboembolism." 3 patients

Journal of the American College of Cardiology
"American Heart Association/American College of Cardiology Foundation guide to warfarin therapy"
J Am Coll Cardiol. 2003;41(9):1633-1652 Dabigatran
Is an anticoagulant in the class of direct thrombin inhibitors.
It is used as an alternative to warfarin to anticoagulate patients whose blood is more likely to form clots such as those with Atrial Fibrillation and heart valve conditions.
However, unlike warfarin patients do not need to have their INR regularly monitored.
Like warfarin bleeding is still a problem.
However, some trials have shown that patients on dabigatran had fewer life threatening intracranial bleeds than those on warfarin but more GI bleeds.
This is thought to be due to tartaric acid which coats the dabigatran and lowers the gastric pH and is required for adequate absorbtion.
At the moment, patients who have stable INRs control with warfarin will gain little by switching to dabigatran and warfarin remains the mainstay of anticoagulant treatment.
In addition currently there is no short term method for reversing the effects of dabigatran.
However, it is a good alternative for those patients who require anticoagulation but whose INRs are not well controlled by warfarin.
Autoimmune, hypercoagulable state caused by antibodies against cell membrane phospholipids that provokes blood clots
Antibodies bind to prothrombin, thus increasing its cleavage to thrombin
Can cause miscarriage, stillbirth, preterm delivery, or severe preeclampsia
Warfarin and heparin are used to anticoagulate these patients Going through the read codes - 8 were wrongly coded.

1 patient. 75 year old female. Had a ?DVT in 98' been on Warfarin ever since. Dr Andy Hughes at Brentwood Community hospital recently took over this patient's care.

Dr Andy Hughes

In the Future...
Full transcript