NOAC Counselling Checklist for its use in the prevention of stroke & systemic embolism in non-valvular AF
New Oral Anticoagulant (NOAC) Counselling Checklist
The following points should be covered when counselling a patient newly initiated on one of the NOAC
Points to cover / Suggested key points / √Link between stroke & AF / · Formation of blood clots in the heart
· Transport of blood clots into the brain causing a stroke
Role of anticoagulants / · Reduces the risk of clot formation in the heart by preventing blood from clotting as quickly and effectively as normal
Name, strength, dose of NOAC / · As per prescription
How to take NOAC / · Apixiban: - Twice daily/ with or without food/ 12 hrs apart
· Dabigatran: - Twice daily/ with or without food/ 12 hrs apart
· Rivaroxaban: - Once daily/ with food to increase absorption
How long to take NOAC / · Normally for the rest of life, unless told by Dr to stop
Importance of Adherence / · Highlight increased risk of stroke if medication is not taken regularly.
· Discuss ways of remembering to take.
· Ensure patient is aware how to order a repeat prescription
Monitoring NOACs / · Reassure patient that there is no anticoagulant monitoring with NOAC
· GP should check kidney function & FBC at least annually
Missed doses & overdose / · Missed doses – take the next tablet as soon as they remember
· Missed doses – see SmPC for specific information
· If an extra dose is accidentally taken contact healthcare team
Storage / · All at room temperature/out of the reach of children
· Dabigatran: -keep in blister packs & not to go in a dossett box
Side effect / · See SmPC for full list of side effects
· Most frequent relate to bleeding and bruising:
· Advise patient to contact Dr immediately if any of the following symptoms of more serious bleeding develop:
o Excessive visible bleeding
o Tiredness, weakness, dizziness
o Unexplained swelling
· Advise patient that the following symptoms require an immediate visit to A&E:
o Vomiting blood
o Blood in urine (red/dark brown), blood in stool (red/black)
o Major nose bleeds (bleeding for more than 10 minutes)
Patient Support Pack / · Check patient has been supplied with the relevant booklet
· Check that the patient has a frequently asked question sheet
· Advise the patient to read the patient booklet and question sheet
· Dabigatran – supply with “Heartmind” leaflet and if possible sign up
Alert Card / · Attached to the patient guide
· Fill in as much detail for patient as you can
· Emphasise the importance of carrying at all time and producing when seeing a doctor
Summary / · When visiting Doctors, Dentists & Pharmacists – advise them that you are taking the medication
· Check if patient has any other question
Matthew Davies/John Halter 10/01/14