NOAC Prescriptions: What Pharmacists Need to Know

Non-vitamin K antagonist oral anticoagulants (NOACs) are increasingly being prescribed to prevent and treat venous thromboembolism and avert stroke in patients with atrial fibrillation.

In light of this NOAC prescription growth, a team of experts recently outlined ways for pharmacists to introduce the therapies to patients more effectively and safely.

“Pharmacists have often been overlooked as part of the information and education chain. We want to correct that,” lead study author Hein Heidbuchel, MD, PhD, FESC, explained to Pharmacy Times in an e-mail. “[Pharmacists] should have also been involved in filling out follow-up information, like on the NOAC cards.”

Dr. Heidbuchel noted that the European Heart Rhythm Association (EHRA) has proposed a universal NOAC patient anticoagulation card, which will clearly include pharmacies in the list of visit sites for patients.

In the meantime, the study authors said the role of the pharmacist is underestimated and underused in monitoring patient adherence to NOAC treatment. They specifically cited the pharmacist’s ability to confirm that patients understand their drug dosages and regimens, as well as reinforce important educational messages.

“Hospital departments or anticoagulation clinics should proactively engage with pharmacists and provide them with education on NOACs, including drug interactions,” the authors wrote.

Pharmacists who have not received such training should adopt the following practices when treating patients on NOACs:

- Ask appropriate questions when dispensing the medication based on the indicated use for the type of patient and medication.

- Make sure that conflicting medications are not prescribed to the same patient.

- Alert the anticoagulation clinic and/or general practitioner about any concerns about the patient.

- Provide educational information to the patient, such as a NOAC card, even during repeat prescription filling.

The researchers also provided a basic educational checklist for pharmacists managing patients starting NOAC therapy.

“The patient should be well informed about their condition, treatment, possible risk situations, and the organization of follow-up care,” the authors concluded. “Only a patient with insight into their condition will be fully adherent to therapy and follow-up, and have a successful outcome.”