Medicines optimisation is a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines. Royal Pharmaceutical Society guidance from 2013 identified the following medicines optimisation principles:

• Aim to understand the patient's experience
• Evidence-based choice of medicines
• Ensure medicines use is as safe as possible
• Make medicines optimisation part of routine practice.

Within the field of anticoagulation, the move away from routine monitoring of anticoagulant activity is a change in practice.

Until DOACs became available, all patients who were prescribed warfarin underwent therapeutic drug monitoring with international normalised ratio (INR) testing as frequently as weekly or monthly.

Pharmacy teams can play an important role in providing patients with information to ensure the safe use of DOACs. DOACs may not be suitable for all patients, and are contraindicated in specific patient groups, including those with cancer or prosthetic mechanical heart valves. Missed and skipped DOAC doses have a greater patient risk when compared to warfarin, due to the short half-life of this drug group.

Community pharmacy teams should identify patients who are prescribed DOACs and offer support via a new medicine service (NMS) or medicines use review (MUR).

Making sense of ‘NOAC’ and ‘DOAC’

Pharmacy teams should be aware that patients and fellow healthcare professionals may be confused by the conflicting terminology used in the naming of anticoagulants. When they first became available, non-vitamin K antagonists were referred to as novel/new oral anticoagulants (NOACs). Now that these medicines have been in use for several years, the term NOAC is considered to mean non-vitamin K oral anticoagulants. However, it has been recognised that the abbreviation NOAC has the potential to be misinterpreted as NO anticoagulation, and some people argue that DOAC (direct oral anticoagulants) may be a safer abbreviation for this drug group.