Managing Non-Warfarin patients
Non-warfarin patients on INRstar?
Patients on non-warfarin anticoagulants can be managed within INRstar. Although these patients no longer need regular INR tests, the national experts still recommend regular clinical review and many anticoagulation services are now adapting their clinics to cater for those patients taking the newer agents.
What non-warfarin drugs are currently supported on INRstar?
Currently supported drugs are apixaban, dabigatran, rivaroxaban, edoxaban, acenocoumarol, enoxaparin (Low Molecular Weight Heparin(LMWH)) and dalteparin (LMWH).
Reviews
*.png"After patients start on a NOAC, it is good practice for clinicians to see them for regular review, preferably every three months" - NICE Implementation Collaborative (NIC) Consensus Statement on the Use of NOACs, June 2014
"Patients on the newer oral anticoagulants come in to our warfarin clinic every 3 to 6 months for a review of their treatment. This allows us to emphasize the importance of compliance, ask about side-effects and ensure that their renal function is checked regularly." - Dr Matthew Fay FRCP (Edin.), GP Principal, Westcliffe Medical Practice; Medical Advisor, Atrial Fibrillation Association
"Reviewing and monitoring our patients is absolutely vital to our service and we are keen to have a means of reviewing patients on different medications in the one place." - Sherra Aynin, Anticoagulation Sister, St. George's Hospital
Recording these reviews in INRstar ensures that those patients are not lost to follow up, and all your anticoagulation patients can be reported on as a whole.
Please note:
- Treatment plans are only able to be set up for drugs licenced to the authorised diagnosis. Non-warfarin treatment plans are not currently able to be set up for custom diagnoses.
- Patients overdue a review will appear in a list on the home page.
- For step-by-step instructions and screen shots, see "related content" links below.
- Patient reviews are filed back to the clinical system (currently only for EMIS Web & TPP SystmOne).
Setting up new patients on a non-warfarin anticoagulant
- Enter the patient demographics as usual (see 'Adding a Patient' in the top right corner of this page under 'Related') and save.
- Set up a treatment plan that specifies the drug, diagnosis and treatment duration for your patient (Treatment Plans > Clinical Details > New Treatment Plan)
- Create a new review that specifies the dose, test results and next review date (Treatment Plan > Reviews)
Changing an existing warfarin patient to an alternative anticoagulant
- Go to the patients treatment plan (Treatment Plans > Clinical Details)
- Click on 'New Treatment Plan' and specify the drug, diagnosis and treatment duration for your patient.
- Create a new review that specifies the dose, test results and next review date (Treatment Plan > Reviews)
Add a New Review
In the patient's record click on the ‘Treatments Plans’ tab and then the ‘Reviews’ tab to get to the annual reviews page.
In the ‘Reviews’ tab click the ‘New Review’ button
Please read the explanations of the different sections of this page below so you can enter in information to each section with confidence
Summary - the review date and type of review
Adherence - record the compliance of your patient taking their tablets.
Previous Adverse Events – will automatically be populated from previous entries.
Risk assessment –patients should have CHADS2-VASc and HAS-BLED assessment scoring recorded.
Test Results - enter in all test results taken.
Dosing - select the dose manually
Clinical Review Notes – Record any additional notes relevant to annual review.
Next Review – This automatically populates to 3 months in advance.
To complete review click the 'Save' button.
This data will now be kept on the 'Reviews' tab which can be viewed at any time.
Edit a next review date
In the patient's record click on the ‘Treatments Plans’ tab and then the ‘Reviews’ tab to get to the annual reviews page.
(If no review date has been set you will see an error icon on and in the ‘Reviews’ tab)
Click on the calendar icon to select a ‘Next Review Date’
To book an appointment for a review please click HERE.
In the patients record click on 
Any reviews that have been created are displayed within the Review Summary table.
Clicking the new Delete Latest button you can delete the most recently completed review shown in the list, providing that you are one of the following users within INRstar.
- Clinical 2
- Clinical 3
- Location Clinical Lead
You will not be able to delete a review if;
- You are not one of the users listed above
- The patient status is Deactivated
- Accessing the patient record via the External Patient Lookup feature
- If the treatment plan has been completed
You can only delete one review at a time and that will always be the most recent one displayed. If the patient has multiple pages of reviews the Delete Latest button will only be enabled on the screen displaying the latest Review.
Deleted reviews are NOT filed back to any clinical system so any changes will need to be made manually, this will appear on a warning message to advise you.
If you use the INRstar clinics feature any associated appointment for the deleted review will also be deleted.
When a review is deleted the Next Review Date will change to that of the Date of the Review that you deleted. If this date is in the past it will appear on the Overdue Review notifications on the Home page.
Any of the above scenarios will display a warning message to you prior to you confirming the action. An example of how that will look is shown below, note this shows all messages where in some cases you many only see one or two.
This process will be audited and will display as follows;
The above image shows, from the bottom up;
- the creation of a review and that it was filed back to the clinical system.
- the review was deleted
- the Next Review Date was changed to that of the review date of the one deleted.