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

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