Blood clotNICE has published its diagnostics guidance on self-monitoring coagulation status in people on long term vitamin K antagonist therapy (warfarin).

In the guidance, NICE recommends self-monitoring with CoaguChek® XS as a cost-effective solution for people to manage their warfarin treatment. The guidance is set to benefit the nearly one million people in the UK who are already on long-term warfarin treatment, the majority of whom are not currently self-monitoring.

Patients taking warfarin require frequent monitoring of their blood clotting levels (international normalised ratio or INR) to ensure that they increase their time in therapeutic range (TTR). The NICE guidance means that more patients with atrial fibrillation or a replacement heart valve who are taking warfarin should be able to self-monitor, which can reduce the frequency of their clinic visits and be less cost intensive for the healthcare system. Self-monitoring leads to improved health outcomes as the patient’s dose of warfarin can be adjusted more regularly, allowing them to increase their TTR compared with those in standard care which reduces their risk of blood clots that cause strokes.

Despite the recognised benefits of self-monitoring, only 15% of GPs in the UK currently offer self-monitoring to their patients, with only 11% reporting that their practice has a policy of providing self-monitoring. In addition, of the 211 Clinical Commissioning Groups (CCGs) in England, only a third currently support self-monitoring. 

The guidance follows publication of the NICE Clinical Guideline on Atrial Fibrillation (AF) in June which ruled out aspirin for managing AF and means that more people will require anticoagulation treatment, placing an additional burden on anticoagulation clinics and hospitals.

Dr Matthew Fay, a GP in West Yorkshire and member of the NICE Atrial Fibrillation Guideline Development Group, said: “The NICE guidance recognises that self-monitoring is accurate and reliable and that warfarin patients prefer the flexibility and reassurance it provides. With the NICE Clinical Guideline on Atrial Fibrillation (AF) published in June recommending that aspirin is no longer used for stroke risk reduction in people with AF, a further 300,000 people will need anticoagulation. Self-monitoring will reduce this increased burden on hospital and clinic resources. Patients taking warfarin should be supported to SelfieChek if it’s right for them and can find out more by speaking to their doctor.”

Dr Martin James, Consultant Stroke Physician at the Royal Devon & Exeter Hospital, said: “Improving the quality of anticoagulation control is a key part of stroke prevention in atrial fibrillation, and for many patients self-monitoring represents a practical and convenient – and evidence-based – way of improving their anticoagulant control. The new NICE guidance published today should mean that more people benefit from self-monitoring, and this will help with the implementation of the separate NICE Atrial Fibrillation Clinical Guideline from earlier this year.”