DOAC - Counselling checklist when starting a new DOAC

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Why this page is important: As DOACs do not require regular INR checks, these patients are not seen by their clinicians as often as warfarin patients, yet the bleed risk is still there! have therefore put together this checklist so I can ensure I give patients all the information they need to ensure they ar equipped from the beginning to take more control over their treatment and to be able to deal with any complications.that may arise.
DOAC Counselling Checklist  Check
Explanation of an anticoagulant (increases clotting time and reduces risk of clot formation)
and explanation of indication for therapy (AF and stroke risk reduction/DVT/PE)
 
Differences between DOAC and warfarin (if applicable for patients converting from warfarin to DOAC therapy o  r offering choice of anticoagulation agent)
·     No routine INR monitoring
·     Fixed dosing
·     No dietary restrictions and alcohol intake permitted (within national guidelines)
·     Fewer drug interactions
 
Name of drug: generic & brand name  
Explanation of dose: strength & frequency  
Duration of therapy: lifelong for AF or explain course length for DVT / PE treatment or prevention  
To take with food (dabigatran and rivaroxaban). Not required for apixaban or edoxaban  
Missed doses:
·     Apixaban and dabigatran can be taken within 6 hours of missed dose, otherwise omit the missed dose
·     Edoxaban and rivaroxaban can be taken within 12 hours of missed dose, otherwise omit the missed dose
 
Extra doses taken: obtain advice immediately from pharmacist/GP/NHS Direct (111)  
Importance of adherence: short half-life and associated risk of stroke and/or thrombosis if non-compliant  
Common and serious side-effects and who/when to refer: symptoms of bleeding/unexplained bruising. Avoidance of contact sports.
·     Single/self-terminating bleeding episode – routine appointment with GP/pharmacist
·     Prolonged/recurrent/severe bleeding/head injury – A&E
Major bleeds managed/reversed by supportive measures, Prothrombin Complex Concentrate (PCC), and availability of antidote
 
Drug interactions and concomitant medication: avoid NSAID’s. Always check with a pharmacist regarding OTC/herbal/complimentary medicines  
Inform all healthcare professionals of DOAC therapy: GP, nurse, dentist, pharmacist i.e. prior to surgery  
Pregnancy and breastfeeding: potential risk to foetus – obtain medical advice as soon as possible if pregnant/considering pregnancy. Avoid in breastfeeding  
Storage: dabigatran m   ust be kept in original packaging – moisture sensitive. All other DOAC are suitable for standard medication compliance aids/ dosette boxes if required  
Follow-up appointments, blood tests, and repeat prescriptions: where and when - will need baseline FBC LFT U&E then either annual/6month/3month depending on renal function  
Issue relevant patient information AF booklet/leaflet and anticoagulant patient alert card  
Give patient opportunity to ask questions and encourage follow up with community pharmacist (NMS – New Medicine Service)  

apixaban dabigatran edoxaban rivaroxaban Warfarin

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