title: Implementation of non-vitamin K antagonist oral anticoagulants in daily practice: the need for comprehensive education for professionals and patients.
abstract: Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly used for the prevention and treatment of venous thromboembolism and for stroke prevention in patients with atrial fibrillation. NOACs do not require routine coagulation monitoring, creating a challenge to established systems for patient follow-up based on regular blood tests. Healthcare professionals (HCPs) are required to cope with a mixture of patients receiving either a vitamin K antagonist or a NOAC for the same indications, and both professionals and patients require education about the newer drugs. A European working group convened to consider the challenges facing HCPs and healthcare systems in different countries and the educational gaps that hinder optimal patient management. Group members emphasised the need for regular follow-up and noted national, regional and local variations in set-up and resources for follow-up. Practical incorporation of NOACs into healthcare systems must adapt to these differences, and practical follow-up that works in some systems may not be able to be implemented in others. The initial prescriber of a NOAC should preferably be a true anticoagulation specialist, who can provide initial patient education and coordinate the follow-up. The long-term follow-up care of patients can be managed through specialist coagulation nurses, in a dedicated anticoagulation clinic or by general practitioners trained in NOAC use. The initial prescriber should be involved in educating those who perform the follow-up. Specialist nurses require access to tools, potentially including specific software, to guide systematic patient assessment and workflow. Problem cases should be referred for specialist advice, whereas in cases for which minimal specialist attention is required, the general practitioner could take responsibility for patient follow-up. Hospital departments and anticoagulation clinics should proactively engage with all downstream HCPs (including pharmacists) to ensure their participation in patient management and reinforcement of patient education at every opportunity. Ideally, (transmural) protocols for emergency situations should be developed. Last but not least, patients should be well-informed about their condition, the treatment, possible risk scenarios, including the consequences of non-adherence to prescribed therapy, and the organisation of follow-up care.
authors.affiliation: Hasselt University and Heart Center, Jessa Hospital, Stadsomvaart 11, Hasselt, 3500 Belgium.
authors.forename: Hein
authors.initials: H
authors.lastname: Heidbuchel
authors.affiliation: Department of Cardiovascular Medicine, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
authors.forename: Dana
authors.initials: D
authors.lastname: Berti
authors.affiliation: Department of Haematology, Thrombosis and Haemostasis, Unit- Centro Hospitalar do Porto, Porto, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Campos
authors.affiliation: Hasselt University and Heart Center, Jessa Hospital, Stadsomvaart 11, Hasselt, 3500 Belgium.
authors.forename: Lien
authors.initials: L
authors.lastname: Desteghe
authors.affiliation: Centre of Thrombosis and Haemostasis, Department of Transfusion Medicine, São João University Hospital, Porto, Portugal.
authors.forename: Ana Parente
authors.initials: AP
authors.lastname: Freixo
authors.affiliation: Immunohaemotherapy Service, Centro Hospitalar Lisboa Norte and Hospital do SAMS-SBSI, Lisbon, Portugal.
authors.forename: António Robalo
authors.initials: AR
authors.lastname: Nunes
authors.affiliation: Haematology and Medical Oncology Unit, Hospital Universitario Morales Meseguer, University of Murcia, Murcia, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Roldán
authors.affiliation: Department of Haematology and Blood Transfusion, Thrombosis Centre, San Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Toschi
authors.affiliation: Department of Haematology, Division of Coagulation Disorders, Cancer Centre, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Lassila
keywords: Anticoagulation clinic; Educational pathways; Non-vitamin K antagonist oral anticoagulant; Patient education