The Key Counselling Points to Address During DOAC Reviews

When transitioning patients from Warfarin to DOACs (Direct Oral Anticoagulants), it is essential for pharmacists to provide comprehensive counselling. During these consultations, patients are presented with a wealth of new information and this can often be overwhelming. Therefore, creating a supportive environment and equipping patients with the all the necessary information is crucial to help them make informed decisions. Inspired by our recent podcast, this article aims to guide pharmacists through these key counselling points and optimise their patient care.

Addressing Similarities:

During the consultation, it is crucial to acknowledge that many aspects related to Warfarin also apply to DOACs. Therefore, it's vital to ensure patients are aware of the following similarities

• Blood thinners: You should emphasise that, like Warfarin, DOACs are blood thinners. In the event of a head injury, they should seek immediate medical attention at A&E.

• Prolonged bleeding: You should inform patients that bleeding may persist longer than normal if they cut themselves. However, if bleeding continues for more than 10 minutes despite applying pressure, a visit to A&E would be warranted.

• Safety warning card: You should ensure the patient is aware that whilst they will no longer need to carry a yellow book, they will still need to carry a safety warning card in their wallet or purse when using DOACs.

Addressing Differences:

In addition to the similarities, it is equally important to highlight the key differences to patients:

• Shorter half-life: You should explain that DOACs have shorter half-lives compared to Warfarin, therefore it's crucial to take it regularly. This includes providing detailed instructions on what to do if a dose is missed. For example, for once-daily tablets, patients should skip the missed dose if more than 12 hours have passed and take the next dose when it's due. Whereas, for twice-daily tablets, there is a 6-hour window to take the missed dose.

Other key points:

In addition to the crucial counselling points above, the following key information should also be addressed.

• Brand name: You should ensure patients are familiar with the brand name of their prescribed DOAC to avoid confusion if the packaging displays a different name.

• Food: It's important to specify if the DOAC requires to be taken with food. For instance, its very important to take Rivaroxaban with food, but for the others it may not be necessary.

• Over-the-counter medications: It's important to advise patients that they must consult with a pharmacist or healthcare professional before using any over-the-counter medication. A common example is ibuprofen- this may not be suitable for many patients taking a DOAC. Patients must inform healthcare providers about their DOAC use before any surgery, including any dental surgery.

• Printed documentation: You should also consider offering patients the option of receiving printed material to refer to. This can be beneficial as patients have a lot of new information to process.

Conclusion:

By addressing the key counselling points outlined above, pharmacists can offer comprehensive support to patients and equip them with the necessary information to make informed decisions. This patient-centred approach enables pharmacists to optimise their patient care and it can also contribute to better medication adherence and patient outcomes.

If you would like to learn more about conducting DOAC reviews, you can watch our recent podcast episode here.

You can also access our free SOP on DOAC reviews which includes further counselling points & script here.