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Abdul Mannan: A Direct Oral Anticoagulant Does Not Need an INR
Abdul Mannan/LinkedIn
Aug 12, 2026, 15:12

Abdul Mannan: A Direct Oral Anticoagulant Does Not Need an INR

Abdul Mannan, Consultant Haematologist at Betsi Cadwaladr University Health Board shared a post on LinkedIn:

“A direct oral anticoagulant does not need an INR.

It still needs a named review date.

The risk is not a missing blood test. The risk is an old VTE decision quietly becoming an unreviewed long-term prescription.

At the 3-month review, decide whether to stop, continue or change treatment. If treatment continues, make the next review visible.

At every review, ask:

  • Is the indication still current?
  • Is the drug and dose right for this phase of VTE treatment?
  • Has bleeding, anaemia, kidney or liver function changed?
  • Have aspirin, NSAIDs or interacting medicines appeared?
  • Is there a procedure, admission, pregnancy plan or adherence problem?

NICE recommends reviewing general health, VTE recurrence risk, bleeding risk and treatment preferences at least yearly for people on long-term anticoagulation or aspirin after VTE.

This is not paperwork for its own sake.

It is how we make sure every anticoagulant prescription still has a current reason, a safe plan and someone responsible for the next decision.

What system does your service use to stop overdue reviews disappearing into the background?

Evidence: NICE NG158, recommendation 1.4.12, last reviewed 1 May 2026.”

Abdul Mannan: A Direct Oral Anticoagulant Does Not Need an INR

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