After a detailed discussion and review of their local protocols, Stuart’s GP commences him on one of the new oral anticoagulants (NOACs). National and local policies are constantly evolving and the role of the NOAC is becoming more and more prominent. Are you familiar with your local policy on the use of these drugs?
The GP talks to Stuart about his results:
Scene 1:
GP: Good morning Stuart how are you and what brings you along to see me today ?
Stuart: Good morning doctor, I”m really well. I”m here to see you because I had checked my pulse and had advice to make an appointment with the nurse. He organised an ECG which apparently confirmed that I have an abnormal heart rhythm called atrial fibrillation.
Scene 2:
GP: Well Stuart, the first thing to say is that I”m really glad you picked up this problem and got advice and then came to see us about it.
Stuart: I understand its quite a common problem with people like me who have a history of previous heart disease. The nurse says she has looked at some charts and I need to take medication which will change the way my blood clots and I”m a bit concerned about this.
Scene 3:
GP: One of the most serious complications of atrial fibrillation is that it increases your risk of having a stroke.
Stuart: That’s what the nurse said but I’m trying to really understand what options I have with medication if I have to take it and how it might impact on my-day-to-day life…
… I’ve read some information on the internet on new drugs that are available. They say that these are just as effective and don”t have the same side effects or interactions as Warfarin.
Scene 4:
GP: I”m really pleased you are feeling well Stuart. I know you take your health seriously and can understand your concerns about the medication.
Stuart: Taking Warfarin frightens me a bit because I”m sure that’s the drug they use to poison rats, is it not ? The bottom line is I feel really well – do I really need this medication?
… I don”t mind taking extra tablets if I understand what benefits they give me but I need to know about any complications they may have as well I feel.
Scene 5:
GP: We have good evidence that the irregular heart rate you have puts you at much greater risk of stroke and we also have evidence that taking anticoagulation medication will help in significantly reducing this risk…
… You are right there are some new medications out now that can be used as well as Warfarin. However its important that we consider the risks and benefits of both and work out together what is best for you.
Stuart: Okay, let’s do that.
Pulse point
Medication compliance tends to be enhanced by full explanations about the reasons for taking the medication. Discuss advantages/disadvantages of different tablets and consider using motivational interviewing skills when patients appear resistant to complying with advice. Check patient understanding and correct misconceptions, such as the apparent futility of taking medication when ‘well’.
Each health board has it’s own policy. NOACs: European Society of Cardiology – European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation
Page last reviewed: 29 Jul 2020
