Inappropriate anticoagulation of patients with a mechanical heart valve

A National Patient Safety Alert has been issued on the risk of inappropriate anticoagulation of patients with a mechanical heart valve.

About this alert

All patients with prosthetic mechanical heart valves require life-long oral anticoagulation with a vitamin K antagonist (VKA), usually warfarin, as these valves predispose the patient to systemic embolism.

Early in the Covid-19 pandemic, published guidance supported clinical teams to review patients treated with a VKA and where appropriate change their medication to an alternative anticoagulant (eg a low molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC)). This was partly to reduce the frequency of clinic attendance for monitoring, and thus reduce the risk to patients. The guidance listed exceptions where specific patients should not be switched from a VKA, including patients with a mechanical heart valve.

However, incidents have been reported of patients with a mechanical heart valve being switched to a LMWH or a DOAC. This alert asks GPs and other NHS providers of anticoagulation services to identify any patients who have a record of a mechanical heart valve and are receiving a DOAC, and to urgently review these patients to ensure they are on the most appropriate anticoagulation therapy and monitoring.

About National Patient Safety Alerts

This alert has been issued as a National Patient Safety Alert.

The NHS England and NHS Improvement patient safety team was the first national body to have been accredited to issue National Patient Safety Alerts by the National Patient Safety Alerting Committee (NaPSAC). All National Patient Safety Alerts are required to meet NaPSAC’s thresholds and standards. These thresholds and standards include working with patients, frontline staff and experts to ensure alerts provide clear, effective actions for safety-critical issues.

NaPSAC requires providers to introduce new systems for planning and coordinating the actions required by any National Patient Safety Alert across their organisation, with executive oversight.

Failure to take the actions required under any National Patient Safety Alert may lead to CQC taking regulatory action.

Patient safety alerts are shared rapidly with healthcare providers via the Central Alerting System (CAS).

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