Anticoagulation

Programme-Anticoagulation

As so many of the common problems in clinical practice today relate to arterial and venous thrombosis, it is important that all healthcare professionals have a clear understanding of the basics of thrombosis/haemostasis and coagulation/anticoagulation pathways. The underlying final pathophysiological process in myocardial infarction and ischaemic stroke is thrombus formation (thrombogenesis). Other common cardiovascular disorders, such as atrial fibrillation (AF), heart failure, peripheral arterial disease and venous thromboembolism, are also associated with thrombogenesis.

In this updated and revised modular programme, we will first be introduced to antithrombotic therapy by examining the mechanism of coagulation and how this relates to the development of arterial and venous thrombosis. Module two will discuss how and why antiplatelet therapy is important, and module three will look at the value of anticoagulant therapy. Later modules consider the clinical aspects of anticoagulation, including the use of anticoagulants in acute coronary syndromes, non-valvular AF, cardioversion, peripheral arterial disease and venous thromboembolism. The role of the pharmacist is also considered.

Each module will have a series of multiple-choice questions. Its five and a half hours of learning leads to five and a half continuing professional development (CPD) credits.

The latest revision of this programme was funded by an educational grant from Bayer. Bayer had no role in the writing of the modules and had no editorial control over the content. The original programme was made available with an educational grant from Bristol Myers Squibb (BMS) and Pfizer UK Limited. It has been independently written by leading UK physicians and pharmacists, and has been endorsed by Anticoagulation UK, the Atrial Fibrillation Association, and Arrhythmia Alliance – the Heart Rhythm Charity.

Original modular programme written by:

Dr Andrew Blann, Consultant Clinical Scientist, City Hospital, Birmingham
Dr Louise Tillyer (retired)

Mr Sotiris Antoniou, Consultant Pharmacist, Barts Health NHS Trust and North East London Cardiovascular & Stroke Network, London
 
2016 revisions by:

Dr Matthew Rogers, Locum Consultant Haematologist, Royal Surrey County Hospital, Guildford; and
Mr Sotiris Antoniou, Consultant Pharmacist, Barts Health NHS Trust and North East London Cardiovascular & Stroke Network, London
2019 revisions (and module 6) by:
Dr Zara Sayar, Haematology Registrar (ST7), University College London Hospitals NHS Foundation Trust
2019 revision of module 5 by:

Mr Sotiris Antoniou, Consultant Pharmacist, Barts Health NHS Trust and North East London Cardiovascular & Stroke Network, London


Anticoagulation module 1: introduction to antithrombotic therapy

Released 10 January 2019   Programme: Anticoagulation 1 CPD/CME credit

Anticoagulation module 1: introduction to antithrombotic therapy
  • Understand the role of Virchow’s triad
  • Discuss the coagulation cascade
  • Recognise key aspects of platelet function
  • Appreciate the consequences of loss of haemostasis
  • Appreciate the importance of antiplatelet drugs in treating arterial thrombosis
  • Explain the role of anticoagulants in treating venous thrombosis

Anticoagulation module 2: antiplatelet therapy

Released 10 January 2019   Programme: Anticoagulation 1 CPD/CME credit

Anticoagulation module 2: antiplatelet therapy
  • Understand the importance of platelets in pathology
  • Be able to discuss the physiology of the platelet
  • Recognise three major routes for suppressing platelet function
  • Be aware of the mode of action of metabolic inhibitors
  • Appreciate the value of ADP-receptor blockers
  • Explain the uses of GpIIb/IIIa receptor blockers
  • Be prepared for the consequences of mis-management of antiplatelet therapy: haemorrhage

Anticoagulation module 3: anticoagulant therapy

Released 10 January 2019   Programme: Anticoagulation 1.5 CPD/CME credits

Anticoagulation module 3: anticoagulant therapy
  • Understand key aspects of the coagulation pathway
  • Discuss the action of heparin, low molecular weight heparin, fondaparinux and vitamin K antagonists such as warfarin
  • Recognise the mode of action of direct oral anticoagulants
  • Appreciate the uses of anticoagulants in acute coronary syndromes and atrial fibrillation
  • Prepare for the consequences of mis-managed anticoagulation, including haemorrhage

Anticoagulation module 4: clinical aspects of anticoagulation

Released 10 January 2019   Programme: Anticoagulation 1 CPD/CME credit

Anticoagulation module 4: clinical aspects of anticoagulation
  • How to initiate anticoagulation with vitamin K antagonists (VKA)
  • Practical issues around VKAs and monitoring
  • When and how to use direct oral anticoagulants (DOACs)
  • Influence of DOACs on laboratory coagulation tests
  • Anticoagulation management around invasive procedures

Anticoagulation module 5: the role of the pharmacist

Released 10 January 2019   Programme: Anticoagulation 0.5 CPD/CME credits

Anticoagulation module 5: the role of the pharmacist
  • Discuss the role of the hospital and community pharmacist in the provision of anticoagulant services
  • Understand the initiation of anticoagulants, and patient counselling
  • Provide pragmatic advice on use of warfarin and direct oral anticoagulants

Anticoagulation module 6: peripheral arterial disease, thrombosis and anticoagulation requirements – the scope of the problem

Released 10 January 2019   Programme: Anticoagulation 0.5 CPD/CME credit

Anticoagulation module 6: peripheral arterial disease, thrombosis and anticoagulation requirements – the scope of the problem
  • Identify peripheral arterial disease and its management
  • Understand the risk factors for venous thromboembolism (VTE) and the management options with direct oral anticoagulants
  • Know about the prevalence of undiagnosed cancer in patients with an unprovoked VTE and the management of cancer-associated thrombosis