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Table 1 Advantages, disadvantages and requirements of proposed models for monitoring of patients taking non-vitamin K antagonist oral anticoagulants or vitamin K antagonists

From: Implementation of non-vitamin K antagonist oral anticoagulants in daily practice: the need for comprehensive education for professionals and patients

Model Initial prescriber HCP responsible for routine follow-up Advantages Disadvantages Requirements for NOAC integration
Nurse-coordinated anticoagulation clinic Hospital specialist Nurse specialist • Nurses well placed to coordinate contact with patients, the initial prescriber and other HCPs • Requires well-educated expert nurses and resources for an anticoagulation clinic • Determination of individual patient visit schedules
• Nurses can take a holistic view (co-morbidities), make a full assessment and educate the patient • Medico-legal liability issues • Easy-to-manage patients could have primary contact through the GP; clinic could function as a coordinator and remote evaluator of care
• Less intensive for the specialist, allowing them to focus fully on the treatment plan   • Non-medical as well as medical aspects and patient preference to be taken into account when considering whether to switch from VKA to NOAC
Nurse-assisted anticoagulation clinic Hospital specialist Cardiologist/haematologist, assisted by nurse • Nurse does not require extensive anticoagulation expertise but can still organise patient visits and provide basic checks and education • Resource- and time-heavy for specialist • As above
GP coordinated, without anticoagulation clinic Hospital specialist or specialist GP GP • Reduces pressure on hospital resources • Increased pressure on GP resources • GPs to maintain contact with patients at a frequency based on patient risks and preferences
• GPs generally know their patients well • GPs must be well trained in anticoagulation (NOACs as well as VKAs) • Specialist department to be available to evaluate the patient at the GP’s request
• Can perform home visits • Good relationship/network needed between hospital departments and local community physicians • GP may rely on the specialist for his/her own education – only well-educated GPs should be prescribers of NOACs
  1. GP, general practitioner; HCP, healthcare professional; NOAC, non-vitamin K antagonist oral anticoagulant; VKA, vitamin K antagonist.