Corona Virus (Covid-19) Blood Clots and other helpful information.
THE NEW ANTICOAGULATION UK PODCAST SERIES
In the first in our podcast series 'Beyond the Blood Clot' we discuss issues surrounding anticoagulation and the Coronavirus. Hosted by Eve Knight, the CEO and Co-founder of the charity Anticoagulation UK, Eve is joined by Helen Williams, National specialty advisor for cardiovascular disease for NHS England.
Anticoagulation and the Coronavirus: Your questions answered
During this uncertain time, Anticoagulation UK will be providing and sharing information and resources.
Please, stay at home to stop coronavirus spreading. If you need medical help for any reason, do not go to places like a GP surgery, pharmacy or hospital. If you have symptoms of coronavirus (a high temperature or a new continuous cough), use the 111 on-line coronavirus service. If your condition worsens and you have difficulty breathing use the 111 telephone service or dial 999.
COVID – 19 Vaccine and anticoagulants
The British Society of Haematology advises that patients with bleeding disorders or taking anticoagulants or antiplatelet medications, require special consideration as there is a slightly increased risk of bleeding due to the intra-muscular route of administration.
- Patients on standard intensity anticoagulation with warfarin (target INR 2.0 – 3.0) can receive intra-muscular injections as long as the most recent INR is <3.0. There is no need to re-check the INR solely for the purposes of vaccination.
- Patients on maintenance therapy with Direct Oral Anticoagulants (Apixaban, Dabigatran, Edoxaban and Rivaroxaban) can delay the dose on the day of vaccination until after the intra-muscular injection but do not need to miss any doses.
- Patients on single agent anti-platelet therapy (e.g. aspirin or clopidogrel) can continue on these medications without any adjustment.
- Patients with higher intensity anti-thrombotic treatment, for example warfarin with a target INR > 3.0 or dual antithrombotic medications, should be managed on an individual basis.
- The bleeding risk can be reduced by application of firm pressure at the injection site for at least 5 minutes afterwards.
- Patients on a full dose of heparin or fondaparinux injections, should also be able to have the vaccine. The daily dose can be delayed until after the injection but there is no need to miss any doses.
If an individual has a history of allergic reaction, please advise the healthcare professional before you have your vaccination.
Clinical guide for the management of anticoagulant services during the coronavirus pandemic
As healthcare professionals we all have general responsibilities in relation to coronavirus and for these we should seek and act on national and local guidelines. We also have a specific responsibility to ensure that anticoagulant care continues with the minimum burden on the NHS. We must engage with management and clinical teams planning the local response in our hospitals and across primary care.
New guidance has been issued for safe switching of patients on warfarin to direct oral anticoagulants (DOACS) for patients with non-valvular AF and venous thromboembolism (DVT/PE) during the coronavirus pandemic.
- Suggested process for safe switching from warfarin to a DOAC (Undertake steps remotely where possible)
- Pragmatic Approach to Stopping Warfarin and Starting DOAC in relation to the INR
- DOAC counselling checklist
Corona Virus and Self-testing for Warfarin Patients
Due to the COVID 19 situation, hundreds of warfarin patients are getting in touch with ACUK and posting on our Health Unlocked social platform asking if they can self-test and how they can get a monitor.
ACUK does not have any supplies of the hand held monitors and these devices are currently not available on the NHS Tariff and have to be purchased directly from the manufacturer, Roche Diagnostics telephone number 0808 1007666. We strongly suggest you do not purchase from any third party advertising on the internet as its likely the price will be inflated greatly.
Guidance for GPs - Anticoagulation during Covid-19 outbreak
The British Society of Haematology, Heamostasis and Thrombosis Task Force released a statement on 26th March 2020 with key points:
- INR is an essential component of safe anticoagulation that cannot be omitted due to social distancing
- Assess whether a DOAC can be used instead of warfarin. Exclusions are
- Mechanical heart valves
- Antiphospholipid syndrome
- Renal failure with creatinine clearance below 15mls/min
- Patient requiring high range INR
- Concomitant use of medication that interacts with DOAC
- If a DOAC is an option consider switching in line with patient's informed consent
- If people have a high TTR then the interval between testing could be extended to 8-10 weeks
- If people have to self-isolate then the INR can be deferred until after self isolation
Scientists are to test whether an experimental drug can prevent potentially deadly blood clots associated with Covid-19
The trial, funded by the British Heart Foundation, will test the theory the clots are caused by a hormone imbalance triggered by coronavirus infection.
It will become one of several drugs currently being trialled to prevent the disease's worst effects.
A third of hospitalised coronavirus patients develop dangerous blood clots.
The drug, TRV027, works to rebalance hormones involved in blood pressure, water and salt.