The British Cardiovascular Society (BCS) has today released a Joint Statement together with the British Heart Valve Society (BHVS), the Society for Cardiothoracic Surgeons (SCTS), the British Society of Echocardiography (BSE), the Primary Care Cardiovascular Society (PCCS) and the British Congenital Cardiac Association (BCCA) on Anticoagulation of Patients with Mechanical Heart Valves.
On 14 July 2021, a National Patient Safety Alert was issued by NHS England relating to choice of anticoagulant drugs prescribed to patients with mechanical heart valves. [1] This was triggered by cases presenting to hospital of patients who had been switched from anticoagulation with warfarin to a novel oral anticoagulant (NOAC).
As a result of the Coronavirus pandemic and the national lockdown in 2020, some patients experienced significant difficulty in continuing blood monitoring of the international normalised ratio (INR). Thus, guidance was provided for patients who could be safely switched from warfarin to newer oral anticoagulant drugs – this did not include patients with mechanical heart valves. [2]
The NPSA stated that fourteen patients with mechanical heart valves have been identified who had been switched from warfarin to alternative anticoagulant drugs – one patient was switched to a low molecular weight heparin (LMWH) and thirteen patients to a NOAC. On subsequent analysis of patient records in primary care, a further 750 patients have been identified who are coded as having a mechanical heart valve and prescribed a NOAC.
