Access to anticoagulation treatments
In patient hospital care
Before or at the time of admission to hospital for surgery or medical reasons, a patient should be assessed as to their risk of blood clots. People will be asked to provide their complete medical history, details of any medications they are taking and whether they have had a clotting episode in the past. This information is important as it will affect the type and level of anticoagulant treatment you may be offered to reduce the risk of blood clots during your stay and for the period of time after you discharge when you may still need protection.
The clinical staff at the hospital will carry out the assessment on admission (or before if elective surgery) and again 24 hours after admission and at any other time if there are changes to your health or changes to your treatment
People should be made aware of the risks of hospital acquired clots and how they will be protected with medication and mechanical prophylaxis such as compression stockings and intermittent pumps which helps the circulation in the legs. You should also be told what you can do to help prevent a blood clot. For patients who are assessed at risk of blood clots but who are unable to take blood clotting medicines, wear compression stockings or use the pumps, they may be offered a Geko device (NICE guidance MTG19) which looks like a small wristwatch that is attached bleow the knee. It stimulates the muscles in the leg and foot and may help to reduce the risk of blood clots forming.
Doctors will decide which anticoagulants are best for you dependent on your medical circumstances – options as below
- Low weight molecular heparin (LMWH) given by injection
- Apixaban - tablet
- Dabigatran - tablet
- Edoxaban - tablet
- Rivaroxaban - tablet
- Warfarin oral - tablet
Apixaban, Dabigatran and Rivaroxaban are anticoagulants and are used during hip and knee surgery and to prevent blood clots in people with Atrial Fibrillation. Apixaban, Dabigatran, Edoxaban and Rivaroxaban can also be given to treat and prevent deep vein thrombosis and pulmonary embolism.
Heparin is also used as a prophylaxis for elective knee and hip replacement followed by one of the newer anticoagulants to extend cover after surgery.
Warfarin is used for treating deep vein thrombosis and pulmonary embolism (blood clot in the lungs) and for some people they may need treatment for six months or life long. Unlike other anticoagulants, warfarin needs to be monitored regularly and this requires frequent blood tests. You will need to have heparin injections at the start of the warfarin treatment until your blood tests show that you have reached the desired target range. This will be explained to you by your nurse or doctor
If you are advised that you need to take an anticoagulant, it can be helpful and reassuring to discuss the options with your doctor to ensure you are able to make the right choice with their guidance. Once you have left hospital, you may continue to be cared for by your GP and they will need to know what treatment you are taking, the duration recommended and whether you need to have regular monitoring.
If you feel that at anytime in the process you have not had an opportunity to have an informed discussion around the choice of anticoagulation available for your condition, you should raise this with your clinician in the first instance.
If they are unwilling to advise or offer you a choice of medicine options and you are concerned, you can ask for your situation to be reviewed in the following way:
At the hospital, you can contact the Patient Advice and Liaison Service (PALS) team who will be able to look into your complaint. Every hospital has a PALS office and details should be available on the hospital website. If you are not satisfied, you can complain to the Commissioner at your local Clinical Commissioning Group (CCG) details can be found here.
At the GP practice, you can speak with the Practice Manager and advise them of the circumstances and they will look into your concerns
If you are being denied access to anticoagulation treatments or access to-self testing if you are taking warfarin, then you can escalate your complaint to the CCG or to NHS England
If you are unhappy with the outcome of your complaint you can refer the matter to the Parliamentary and Health Service Ombudsman, who is independent of the NHS and Government.
Information relating to the NHS Complaints procedure can be found here
You may decide to talk to your Member of parliament about your complaint. You can find out who your MP is here: http://www.parliament.uk/mps-lords-and-offices/mps/
AntiCoagulation Europe (ACE) aims to help individuals who may need support and guidance in accessing treatments. Resources such as template letters to help in the preparation of a complaint are available on the ACE website www.anticoagulationeurope.org
If you need any additional support contact ACE at firstname.lastname@example.org or phone the helpline on 0208 289 6875 (manned during core office hours and answer machine facility)