Terry Dowling is Principal Pharmacist, Haemostasis & Thrombosis, Guy’s & St. Thomas’ NHS Foundation Trust.
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Local guidance, supported by the 2014 National Institute for Health and Care Excellence (NICE) guideline CG180 for atrial fibrillation (AF), recommends that patients receiving inadequate anticoagulation with a vitamin K antagonist (VKA), including time in therapeutic range (TTR) of <65%, should be reassessed. These patients were identified by the anticoagulation monitoring service (AMS) and highlighted to GPs for review. However, up to 59.3% of patients received no revie