COVID-19 - Advice to patients of the Anticoagulation Department
**If you have tested positive for Covid-19 please contact our clinic for advice on continuing your medication. Please do not attend clinic. You must follow Government isolation guidance**
As part of the Anticoagulation Clinic’s on-going response to the COVID-19 (coronavirus) pandemic, we continue to put measures in place to protect patients, visitors and staff. In order to reduce hospital visits, we are making some changes to out-patient appointments. Our clinics at DATU Nobles Hospital, Ramsey Cottage Hospital, Peel GP practice and Thie Rosien in Port Erin remain open, strictly by appointment only. You must gel your hands on entering and exiting these buildings and wear a face mask.
We will continue to offer virtual appointments where possible (by telephone), or where clinical teams feel it is safe to do so, rearranging or cancelling appointments.
If your appointment is changed to a telephone appointment, please note the number may appear as a private or unknown caller. Please do pick up. If you do not hear from us, please attend your appointment as planned.
It is essential that you attend your clinic appointment at the time you have been given - this ensures we can avoid waiting in the clinic area and apply social distancing.
COVID 19 Vaccinations and Anticoagulants
You may have been invited to have a covid vaccination. Taking anticoagulants does not exclude you from having an intramuscular injection, you just need to be aware that there may be increased bruising so you should apply pressure to the injection site.
Individuals on stable anticoagulation therapy, including individuals on warfarin who are up-to-date with their scheduled INR testing and whose latest INR is below the upper level of the therapeutic range, can receive intramuscular vaccination. A fine needle (23 or 25 gauge) should be used for the vaccination, followed by firm pressure applied to the site without rubbing for at least 2 minutes. The individual/parent/carer should be informed about the risk of haematoma from the injection. If you need further advice please contact our clinic Tel 650643 or email firstname.lastname@example.org
If you, or someone living in the same house as you, develops either of the following symptoms:
- a new, continuous cough
- a high temperature (38°C or higher)
- loss of taste or smell
- new onset of shortness of breath
Please stay indoors and keep away from others following the Government advice of self-isolation for 14 days. Please do not come in for your hospital appointment.
- All new patients will continue to be seen in clinic unless/until advice is received that they should no longer attend. We have asked GP’s to commence Direct Oral Anticoagulants and provided prescribing guidance for primary care. We can isolate when we see new patients, as long as referral rates remain current.
- Lead CNS reviewing weeks ahead clinics and re-scheduling appointments for those patients deemed at risk. The Lead CNS will look through the same to identify any patients who they feel should attend their appointment.
- The Anticoagulation Team will offer virtual appointments via telephone consultations to those patients on DOACs to avoid hospital visits - except for those patients already identified by the Lead CNS who they feel would benefit from face-to-face consultations. Due to the volume of this activity, this will be dedicated to several nurses.
- Patients will be encouraged to avoid presenting to the Emergency Department for minor bleeding issues that can be addressed at home or with phone support from the clinic. These include minor cuts, bruises, and nosebleeds.
- Stable patients will be offered extended INR testing up to an interval of 12 weeks. This cannot be routinely recommended for unstable patients or out of range INR test. The Team will assess the risk/benefit needed in patients with out of range INRs in order to individualise this approach and communicate clinical decisions to the patient.
- If patients prescribed long-term anticoagulation develop COVID-19, as with any acute illness, the INR may be affected. This is especially true if there is diminished dietary intake and/or diarrhoea.
- Domiciliary visits to housebound and vulnerable patients will continue and the team will contact patients beforehand to ensure that they have no symptoms. All nursing homes and care homes are currently allowing our staff to visit patients and take their INR. PPE will be available to all staff on these visits.
- The CNS will assess whether established warfarin patients with NVAF or VTE might be good DOAC candidates and, if so, consider switching during hospital admission to look at which patients could convert to a DOAC safely as an outpatient or home visit and explain the clinical choices to the patients.
- Self-testing represents a great option to promote the continuation of INR testing in patients who are practicing social distancing. This will continue to be supported by the team and will not change. There may be more patients willing to self-test due to prolonged period of social distancing.
- “Work from home” approach is not possible, the Anticoagulation Clinic Team will work closely with their management and infection control teams to identify strategies to minimise any exposure risk to patients and staff.
- These measures are to help protect patients and staff.
The anticoagulant service provides all aspects of care for patients receiving anticoagulation on the Island.
Appointments are by referral only from your Doctor.
Tuesday 9am to 12pm
Tuesday 1.30pm to 4pm
Wednesday 9am to 12pm & 2pm to 4pm
Friday 9am to 12pm
Tuesday 9am to 11.30am
Thursday 1.30pm to 4pm
Thie Rosien in Port Erin
Thursday 9am to 11.30am
Clinics are not open on Bank Holidays
For advice or to alter your appointment please telephone +44 1624 650643.
This will connect you to a message service. When you leave your message please make sure you include:
- Your full name
- Your date of birth
- Your hospital number
- Your telephone number
Blood-thinning drugs (anticoagulants)
These drugs decrease the clotting ability of the blood and prevent clots from forming in the blood vessels. They will not dissolve clots that have already formed but help stop clots becoming larger and reduce the risk of further clots.
Reducing the blood's ability to clot is important in preventing conditions such as strokes and heart attacks. Anticoagulants are given to people who have a history of these conditions or who are at risk of developing them. Other high risk groups include people who have deep vein thrombosis, pulmonary embolism, angina, atrial fibrillation (AF), cancer and artificial heart valve replacement.
Starting warfarin as an outpatient
If you are referred as a new outpatient to start warfarin you should expect to receive an outpatient appointment date within 1 or 2 weeks. At your appointment, which should take around 30 minutes, we will give you information about warfarin and explain in detail what warfarin therapy entails. You will need a finger prick blood test (INR) and the results of this test discussed at your consultation. People taking warfarin need to have regular blood tests to see how well the drug is working. We will check how long it takes for your blood to clot by using a measurement called an INR (International Normalised Ratio). There is no standard dose of warfarin and everybody needs their own specific, personal dose.
Your dose of warfarin will then be decided and your next appointment arranged.
Starting warfarin as an inpatient
If your warfarin has been started as an inpatient we will see you before you go home to give you all the information about warfarin and make arrangements for your blood tests to be done after you go home.
You may be suitable for self-monitoring your INR at home. Please ask a member of the team for more information.
New Oral Anticoagulants
Alternative drugs such as Dabigatran, Rivaroxaban, Apixaban or Edoxaban. These drugs are still anticoagulants but have a fixed dose so do not require INR monitoring. Surveillance clinics have been established to help support patients taking these drugs.
Visitors to the Island
If your local anticoagulation clinic has requested you have your INR test whilst you are visiting the island, please contact us to arrange an appointment Tel: +44 1624 650643
If you are a non UK resident there will be a charge attached to this test.