Haematology

The following reports are available to help improve the care of patients receiving anticoagulation.  One particularly useful strategy is to set these reports to run in a batch process (Automated Reporting) to go your cardiovascular/AF lead at regular intervals (1-2 monthly is a reasonable frequency).  The reports highlighted in bold font would be the most suitable ones to add. 

Patients who feature in these reports will also have this information shown on the anticoagulation and AF templates. 

The reports are in the folder CDRC Quality > Haematology 

A spreadsheet is available to support the anticoagulant safety audits – Anticoagulant Safety Audit 

Report Name	Returns	Action
? Anticoagulation Safety 01 – ?Poor Concordance #	Patients with repeat anticoagulants who have not had a recent issue within 3 months (NB will ‘incorrectly’ detect people who have recently started treatment in secondary care and not had first primary care issue)	Review patient and discuss concordance if appropriate
? Anticoagulation Safety 02 – Antiphospholipid Syndrome – consider stopping	Patients on a DOAC with antiphospholipid syndrome EMA Warning **	Review the patient and consider stopping/switching to VKA
? Anticoagulation Safety 03.0 – Consider Reduced Dose – hard reasons #	Patients on DOAC who may need a reduced dose due to factors such as age, weight, eGFR, interacting medication – based on the medicine summary of product characteristics	Review the patient and consider DOAC dose
? Anticoagulation Safety 03.01 – Consider Reduced Dose – hard reasons (AF only) #	As above but only for patients with AF.	Review the patient and consider DOAC dose
? Anticoagulation Safety 03.11-3 – DOAC – Consider Reduced Dose/Change DOAC – >=x soft reasons #	Patients on DOAC who may need a reduced dose or a different DOAC due to multiple ‘soft’ factors such as age, weight, eGFR, interacting medication – based on the EHRA guideline 2021	Use the anticoagulation template to review factors and consider whether different DOAC/dose is required
? Anticoagulation Safety 03.2 – Has >=2 soft issues that could reduce levels #	Has >=2 issues that might cause a reduction in DOAC levels e.g. interacting drugs, obesity	Use the anticoagulation template to review factors and consider whether different DOAC/anticoagulant is required
? Anticoagulation Safety 03.3 – DOAC – Edoxaban and CrCl > 95 #	Patients on edoxaban with CrCl >95	Consider an alternative DOAC
? Anticoagulation Safety 04 – Severe renal impairment – consider stopping #	Patients on DOAC with renal function below the recommended lower safe limit	Review the patient and consider DOAC safety
? Anticoagulation Safety 05 – No apparent indication #	Patients on DOAC without clear indication	Review the patient and consider suitability of DOAC or add indication as appropriate
? Anticoagulation Safety 05.1 – No apparent licensed indication #	Patients on DOAC without clear licensed indication – NB that the DOACs are only licensed for the AF indication when certain risk factors are present.	Review the patient and consider suitability of DOAC or add indication as appropriate
? Anticoagulation Safety 06 – Contraindicated/not recommended drugs #	Patients on DOAC with a contraindicated/not recommended concomitant medication	Review the patient using the anticoagulation template and consider DOAC safety
? Anticoagulation Safety 07.1 – Consider Dose Increase  #	Patients on DOAC who may need a dose increase. *** 7.2 – Based on SmPC licensed criteria 7.21 – Based on SmPC licensed criteria but excluding those with >=2 soft criteria for reduced dose	Coding may be inaccurate or consider dose increase
? Anticoagulation Safety 08.1/2 – Cockroft Gault CrCl Record Overdue #	Patients on a DOAC who don’t have a recording of Cockroft Gault creatinine clearance within a relevant time period (depending on their renal function) 8.1 – Test done report – renal function checked but CG not calculated 8.2 -Test not done report – patient needs blood test	Either: Use the anticoagulation template to record CG CrCl based on last eGFR OR Call patient for U+E if not done in relevant time period.
? Anticoagulation Safety 09 – High GI Bleed Risk – no gastroprotection #	Patients in the report above who are not on gastroprotection	Consider need for gastroprotection
? Anticoagulation Safety 10 – Warfarin or VKA – No INR in the last 12w #	Patients on vitamin K antagonist with no INR record in the last 12 weeks	Check/record INR
? Anticoagulation Safety 11 – Warfarin or VKA – No TTR in the last year #	Patients on vitamin K antagonist with no INR record in the last 12 weeks	Record TTR
? Anticoagulation Safety 12 – Warfarin or VKA – Latest TTR <65% #	Patients on vitamin K antagonist whose latest recorded TTR is <65%	Review the patient and consider vit K antagonist safety +/- update TTR
? Anticoagulation Safety 13 – Warfarin or VKA – Poor control (NICE criteria) #	Patients on vitamin K antagonist with poor control according to NICE criteria	Review the patient and consider vit K antagonist safety
? Anticoagulation Safety 14 – Duplicate Anticoagulant #	Patients on more than one anticoagulant	Consider stopping one
? Anticoagulation Safety 15 – DOAC and heart valve #	15 – any valve which isn’t specified as tissue 15.1 – any mechanical valve	Review record. Stop DOAC if mechanical heart valve or replace non-specific heart valve code with tissue heart valve.

** There is a separate report to identify patients who appear to have an autoantibody associated with the antiphospholipid syndrome but not a read code for antiphospholipid syndrome.  Clinical review would be necessary to assess if these patients have the syndrome. The report is in the same folder and is called: 

Thrombophilia – ? Antiphospholipid Syndrome Casefinder – Probable positive antibody # 

*** There is a separate report to identify patients who might need an increase in DOAC dose, who do not have either a hard reason for reduction or >=2 soft reasons.  Specialist advice may be needed for patients with softer reasons to reduce or increase doses. 

When the Anticoagulation – CDRC Template is opened from another CDRC resource it will automatically open on the relevant drug page if the patient is receiving repeat anticoagulants. Otherwise, it will open the home page. 

How to Access:

With the Patient record retrieved, in the lower left hand corner there is a search bar, type in ‘Anticoagulation – CDRC’ and select the following template:

Alternatively, press F12 and type in ‘Anticoagulation – CDRC’ in the search bar, this will return the aforementioned template.

Anticoagulation Template

The Home page gives an overview of the patient’s current and previous Anticoagulation prescriptions.

Expanding the drop down next to the Medication (in this case Apixaban 2.5mg tablets) further information is shown.

Each DOAC has a specific page on the template which provides an overview of important information and monitoring. 

For each anticoagulant there is a page showing important information about indications and dosage.  Relevant information from the patient’s record is shown in the right hand panel.

The Anticoagulation Checklist allows for the checking and recording of key information including: indication, duration, safety information provided to patients. The check will run through a series of safety checks looking for patient specific issues.  It will conclude with a safety checklist to discuss with the patient. 

For practices who have recently joined the DCS group on SystmOne, PSAs and Protocols will not be automatically active. You can choose the level of activation you would like; opt-in to all or resource specific CDRC resource PSAs and Protocols. Alternatively you can choose not to opt-in and only use the Reports and Templates.

If you would like to activate that following, or all, CDRC PSAs and Protocols, please email contact-cdrc@healthinnovationnenc.org.uk

The opt-in anticoagulation resources include any of these resource bundles: 

• Everything bundle 
• Medication safety bundle 
• Anticoagulation bundle