Practical introduction of novel oral anticoagulants through an anticoagulation nurse. The Leeuwarden model

Abstract

Introduction: This paper describes the implementation of novel oral anticoagulants (NOACs) through an anticoagulation nurse. Logistics and tasks of this new function are described and preliminary data are presented.

Methods: Indications for NOACs are explained by the treating cardiologists. Thereafter, the patient is referred to the anticoagulation nurse before starting a NOAC. After providing a patient with information and checking the creatinine clearance, co-medication and medical history, a prescription for NOAC is made.

Results: In 3 months, 51 patients were referred for NOAC therapy. Mean age was 68 years, CHA2DS2-VASc score was 2.9. Renal function was impaired in 28 %. Only 63 % of the patients had an uneventful start-up. NOAC therapy was withheld or prematurely stopped in 22 %. 30 % of patients needed a reduced NOAC dose. In 37 %, the anticoagulation nurse had extended patient contact, mainly because of (presumed) side effects.

Conclusion: Given the number of interactions that were made using a separate patient contact through the anticoagulation nurse, this seems to be an important improvement in the quality of care and deserves further expansion.

Fig. 1

Flowchart of patients