National Integrated Anticoagulation Service (NIACS), OPT-Thrombosis and Thrombosis Registry
The first ever integrated anticoagulation service in the region was set up at the Department of Cardiovascular Medicine at Shifa International Hospital Islamabad, Pakistan in 2012.
It is a medical officer led service that provides an integrated outpatient and inpatient specialist anticoagulation service to patients on the anticoagulation therapy. In the beginning, its role was providing advice and monitoring the optimal dosage of those treated with warfarin. However, it has extended its role by also providing support concerning patients on the newer direct anticoagulants (NOACs) and parenteral heparins and other agents. Furthermore, through setting up a formal pathway to prevent risk of thrombosis in the admitted patients, the service has addressed this very crucial aspect of prophylaxis management of individuals at high risk of developing venous thrombosis.
Patients on anticoagulants can consult the service over the phone or seen at the clinic. They are provided advice and instructions concerning their specific anticoagulant agent use. Patients also get general medical health advice at this service and dietary plan while on warfarin(Coumadin). They are issued an anticoagulation booklet to keep record of their INR and dosages. It also has sections on the information about anticoagulation, medications, and other related topics in Urdu.
Portable INR machines: Considering the issue of lack of either the facilities or quality of INR estimation tests, patients from far flung areas are encouraged to invest in the portable INR checking machine CoaguChek® XS system. This is a well-validated instrument for reliable monitoring of anticoagulation therapy for patients on warfarin. Although expensive at RRP of Rs 100,000, it is available to our patients for Rs 25,000 only. Few of these machines are placed at Shifa Hospital pickup points as an extension of our service. There is a plan to make these machines available at locations with no current availability of INR testing facility.
OPT – Thrombosis and Thrombosis Registry: OPT – Thrombosis (Optimal Proven Therapy in Thrombosis) and Thrombosis Registry have been set up as initiative and patients database to optimize the management of patients and to create and maintain the demographic and clinical information on patients from across the country. This registry is created to serve the patients, physicians, and research communities.