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.”

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