Pharmacists should make patients on warfarin aware that they may be able to self-monitor their risk of developing blood clots, a clinical expert has said.

Nice recommended two self-monitoring coagulometers yesterday (September 24) and community pharmacists should familiarise themselves with the products in case they were asked about alternative treatments by patients on warfarin, said Frances Akor, consultant pharmacist for anticoagulation at Imperial College London.

Pharmacists needed to be aware that the meters were only recommended to adults on long-term anticoagulation therapy – such as warfarin – who suffered from atrial fibrillation or heart valve disease, Ms Akor told C+D.

Some clinical commissioning groups (CCGs) were willing to purchase the devices on behalf of patients and pharmacists should find out whether this was the case in their area, she said.

"Patients might have questions about the cost. It would be useful for community pharmacists to know what's happening in their locality: are patients in charge of doing it for themselves or are CCGs willing to fund the monitor?" she added.  

In its guidance, Nice recommended both the CoaguChek XS system and the INRatio2 PT/INR device as ways to monitor the risk of clotting. Both monitors had a similar level of accuracy to laboratory-based testing, Nice said.

The monitors would allow patients to measure the time it took their blood to clot "almost instantly" and then either contact a healthcare professional for advice or adjust the dosage of their medication themselves based on an agreed care protocol, it added.

Staying out of hospital

Nice said using coagulameters could reduce the frequency of visits to hospitals or anticoagulation clinics and allow the clotting tendency of patients to be monitored more regularly. This could reduce the risk of heart attacks and strokes by enabling the dose of therapy to be adjusted more accurately, it said.

Professor Carole Longson, director of Nice's health technology evaluation centre, said allowing patients to monitor themselves could also "reduce the anxiety" of waiting for results and give them "a sense of control".

In June, Nice advised prescribers to consider new anticoagulants as an alternative to aspirin when treating patients with atrial fibrillation.

	Would you feel happy recommending self-monitoring devices to your patients?