Improving anticoagulation management
Project Leader: Dr Kamal Mahtani, NIHR Clinical Lecturer
One body of work that Kamal has used his clinical lecturer award to develop has been around anticoagulation. He is due to complete the final of three first-author Cochrane systematic reviews in this area.
The first review was around the optimal loading dose of warfarin for initiation. In the review Kamal and his team showed that there was little difference in initiating warfarin using different dosing regimens and achieving the target INR. The systematic review published in 2012 is cited in the NICE NHS Clinical Knowledge Summaries guidance on the topic.
The second review, published in 2014, involved investigating the role of low dose vitamin K in increasing the INR stability of patients taking warfarin. Dietary vitamin K is known to influence a person’s response to warfarin. Foods rich in vitamin K include green leafy vegetables. However, Kamal and his team found some evidence that a low dose of oral vitamin K can increase the INR stability in patients with poor control.
The final review is due to be published later in 2014, and is a review of the effectiveness of novel anticoagulants (NOACs), such as dabigatran, in preventing stroke in patients with atrial fibrillation.
Kamal’s work is carried out largely at The Nuffield Department of Primary Care Sciences alongside the Centre for Evidence-Based Medicine. However, through his clinical lecturer post he has built up collaborations both within the UK and internationally.