Ireland’s first ‘drive thru’ warfarin clinic has been established at Tallaght University Hospital in Dublin

Picture shows; Anticoagulation nurse specialist Katherine Quinn operating the new ‘drive thru’ warfarin clinic with patient with Mr Archie McKeown, at Tallaght University Hospital .

The arrival of the coronavirus pandemic has changed the way medicine is practised with a lot of services coming up with new ways to care for patients in a safe and secure manner. One such service is the anticoagulation and atrial fibrillation clinics in Tallaght University Hospital, which has established Ireland’s first drive thru warfarin clinic.

Warfarin is a blood-thinning drug, which is prescribed for people at risk of stroke or those with some heart conditions like atrial fibrillation.

With atrial fibrillation (sometimes called A Fib) your heart beats in a disorganised and irregular way, which can lead to a range of symptoms and potential complications, including stroke, permanent heart damage and heart failure.

If you have atrial fibrillation and are not treated, you are five times more likely to have a stroke. Atrial fibrillation is the most common type of irregular heartbeat, with one in four people over the age of 50 at risk of developing it.

Warfarin has largely been replaced by newer oral anticoagulation drugs but there is a small cohort of patients that are not suitable or simply do not want to change to these new drugs. These include people who for clinical reasons need to stay on warfarin such as those with mechanical heart valves, those with poor kidney function and people with a number of rare conditions.

For most other people switching to the newer oral anticoagulation drugs means that they do not need to be monitored as regularly as those on warfarin.

Unlike the newer drugs people on warfarin need regular monitoring some as regularly as every two – three weeks. However, the arrival of the coronavirus pandemic in Ireland had made patients understandably worried about coming into hospital for these checks.

In an effort to reassure patients and ensure they continue to come to the clinic to have their regular INR levels checked, the anticoagulation and atrial fibrillation service in Tallaght University Hospital has devised a system where patients of the hospital can phone in advance and get an appointment for their check-up.

However, instead of having to attend the clinic in the hospital they can simply drive up to the entrance of the day hospital where they are met by staff in the who preform a finger prick blood test to check their warfarin levels.

Commenting on the new service Professor Rónán Collins, Consultant Geriatrician and National HSE Clinical Stroke Lead said it was developed first of all to reassure patients that they could safely be monitored as normal if they needed to or preferred to stay on warfarin or be switched over to the newer drugs if they preferred.

Prof Collins said it was vital that patients on warfarin particularly those who needed regular monitoring get their levels checked and it could be “dangerous” to miss appointments with the anticoagulation clinic.

“We set up a drive through clinic for the patients so they don’t have to come into the hospital premises but rather we meet them outside our day hospital. The anticoagulation nurse staff do a finger prick test from the window of the patient’s car in full Personal Protection Equipment (PPE). We will ring the patient later that day with their INR and recommend the next dose of warfarin and time of next test, or should they wish to switch to a newer agent, recommend a best choice for them and explain to them how to move to the new drug and then email the prescription to their pharmacy,” he explained.

According to Prof Collins, it is vital that patients on warfarin continue to attend for regular checks because either the warfarin level will go too high which puts the patient at risk of bleeding or the warfarin level will go too low which will mean they are more likely to form a clot and have a stroke.

There are currently 1,000 patients on warfarin who attend Tallaght University Hospital and on average they would need it monitored every six weeks or so but some people need to attend more or less frequently.

Prof Collins paid huge credit to the staff at the anticoagulation and atrial fibrillation services in particular Clinical Nurse Specialists Katherine Quinn and Jenny Moriarty; Staff nurses Georgina Broderick and Edith Amoroso as well as his clinicians Drs Ciara O Rafferty and Johnny McHugh.

We are here for you

The Irish Heart Foundation’s nurse support line is available five days a week. Anyone living with heart disease and stroke who has concerns or questions about the coronavirus can contact the nurse support line on 01 668 5001 or support@irishheart.ie.

The Irish Heart Foundation’s new heart support group is on Facebook. Anyone who lives with heart failure or another heart condition or has a family member living with a heart condition can join here: www.facebook.com/groups/heartsupportnetwork/

The Irish Heart Foundation runs 21 stroke support groups and 5 heart failure groups around the country. All these groups have moved to telephone and online support. For more information, see https://irishheart.ie/get-support/.