Topics in this Dawn AC E-Newsletter

Top Programme - Dawn AC User Group 21/22^nd Nov. 2005
Benefits of Warfarin after Myocardial Infarction outweigh the Risks
Improve your Benchmarking Results
Dawn AC Training – Ad Hoc Report Writer/User Letters

Top Programme -Dawn AC User Group 21/22^nd November 2005

Do not miss out; we have some great talks lined up for this year’s User Group Meeting based in the Heart of the beautiful English Lake District. Please send in your application form as soon as possible. Here is the provisional list of talks:

Provisional Programme so far

· "Comparison of Pharmacy Managed System with Conventional Care" Dr Daniel M Witt, Head of Anticoagulation, Kaiser Permanente, Denver, USA

· "Direct thrombin inhibitors - will they be too expensive for routine use?" Dr Eric J Watts, Consultant Haematologist, Basildon & Thurrock Hospitals

· "Treating Atrial Fibrillation Patients" Dr David Wright, Consultant Haematologist, Pontefract General Infirmary.

· "How to Manage Patients to Prevent Bleeds using Dawn AC" Dr Anne-Louise Swain, Sullivan & Nicolaides Pathology, Brisbane, Australia

· The “Leicester Experience” Marie Copple, Nurse Practitioner, Leicester University Hospital

· “How we use Dawn AC for Near Patient Testing” Lynda Mullahy, Clinical Nurse Specialist, Leicestershire Anticoagulation Monitoring Service (LAMS)

· “Capillary versus Venous INR” Susan Dunhill, BMS II, North Tyneside Hospital

· “Development of a Unified AC Service using a Multidisciplinary Team”, Hazel Mather, Chief BMS, Southport District General Hospital

· “A Dedicated Atrial Fibrillation Clinic – the reasons Why” Lillian Webb, Nurse Specialist, Kettering General Hospital

· There will be a number of sessions on the new Web browser based Dawn AC version 7

I am still looking for very short talks on practical tips and solutions that folks have used to help make their anticoagulation service better. Speakers are given a discount of £100 on the cost of the conference.

Please call for more information or to discuss with me your ideas for a talk.

Benefits of Warfarin after Myocardial Infarction outweigh the Risks

In the Ann. Intern. Med. 2005;143:241-50 a meta-analysis is presented about the benefits of adding warfarin to aspirin after myocardial infarction. The authors of an 11000 patient year study concluded that the benefits of adding warfarin far out weigh the risks for most patients.

They estimate that for a man at high cardiovascular risk and low bleeding risk, the number needed to treat to prevent a major cardiovascular event is 16 and the number needed to harm is 333.

In a recent ‘Short Cut’ in the British Medical Journal (3 Sept. p477), comments on this work stating that Doctors are often reluctant to start patients on warfarin even in circumstances when well-established guidelines recommend it. They worry about the inconvenience to the patient and that the increased risk of bleeding may offset any benefit.

So despite the evidence from randomised control trials, the practice has not been widely adopted.

A ‘Dawn’ Thought: Would the use of a computer aided software package help here in helping cope with the increased patient numbers and also minimising the bleed risk?

Improve your Benchmarking Results

We are often asked to give suggestions on how a customer can improve their percentage time in range results. From an inspection of the benchmarking results, it would appear that the poorer performing centres, lose out on a higher time below range. There seems to be two reasons for this:

1) They do not appear to be adjusting the dose upwards sufficiently, when the INR is low, presumably for the fear of causing a bleed. This was confirmed by a more detailed analysis that indicated in a high percentage of occasions, the patients were either left on the same dose or the increased dose fell short of that recommended by the computer.

2) The length of the interval to the next test was not shortened to a safe minimum when the INR was below range. In other words, keep your interval as short as possible when the INR is out of target range.

I would suggest that centres that wish to improve should examine their practice in this area.

Dawn AC Training – Ad Hoc Report Writer/ User Letters

On the 23rd November, the day after the User Group, we are planning two half-day training sessions at The Blue Bell Hotel, Heversham, South of Kendal on Ad Hoc Report Writing and User Letter Definition.

The course costs £125 plus VAT per half day. If you are interested please let us know as soon as possible.

Syd Stewart

End of Newsletter

“We Really Care"

“Dawn AC is an easy to use, adaptable, powerful, and comprehensive PC based Anticoagulation Software System. It covers the complete oral anticoagulation life cycle with Induction and Maintenance Modules “

“Lancet Nov 7th 1998, Multi-centred Randomised Trial using Dawn AC shows computer aided dosage leads to INR control 20 to 30% better than medical experts”