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Publication Type: Safety Alert
Single or Multiple Incident: Multiple
Date: 7/14/2021 12:00:00 AM
Country: United Kingdom
Organization: NHS Commissioning Board
This alert discusses the safety incidents which can occur when patient with a mechanical heart valve is switched from a vitamin K antagonist (usually warfarin) to an alternative anticoagulant such as a low molecular weight heparin or a direct oral anticoagulant. While patients with prosthetic mechanical heart valves require life long anticoagulation to prevent emboli formation, the type of anticoagulant used is critical. During COVID-19 there was a move to transition patients treated with a vitamin K antagonist to another anticoagulant which would reduce the frequency of clinic attendance for monitoring. However, since March 2020, there have been adverse events in patients whose medication was switched. The alert provides recommendations to practitioners to ensure safe anticoagulation in patients with mechanical heart valves.

Additional Details

Device:
mechanical heart valve
Medication/Gas/Fluid:
anticoagulants, vitamin K antagonist, warfarin, low molecular weight heparin, direct oral anticoagulant
Medication/IV List:
antithrombotic agents (anticoagulants)

Rules / Policies / Procedures
  1. If you have received a ‘task’ from EMIS (general practice software) identifying specific patients who have a record of a mechanical heart valve and are receiving a direct oral anticoagulant, and you have not already actioned this request, urgently review these patients to ensure they are on the most appropriate anticoagulation therapy and monitoring.
  2. If you have received a ‘task’ from TPP (general practice software) identifying specific patients who have a record of a mechanical heart valve and are receiving a direct oral anticoagulant, and you have not already actioned this request, urgently review these patients to ensure they are on the most appropriate anticoagulation therapy and monitoring.
  3. Practices using other general practice system software: urgently review all patients with a mechanical heart valve to ensure they are on the appropriate anticoagulant therapy and monitoring.
  4. Providers of anticoagulation services: a. Urgently check patient records from January 2020 to identify any patient with a mechanical heart valve who has been switched from a vitamin K antagonist to an alternative anticoagulant. b. For identified patients you should either: i. Urgently review these patients if still under the care of the service to ensure they are on the appropriate anticoagulant therapy and monitoring or ii. Work with the patient’s GP to ensure the patient receives an urgent review.

Inappropriate anticoagulation of patients with a mechanical heart valve