The Dedicated Anticoagulation Clinic (DAC) is a structured and protocol driven service offered for thebenefit of patients whose clinical state dictate the use of anticoagulation.
The clinic is under the control of the National Cardiothoracic Centre of Excellence (Cardiac Centre) but provides service to the entire hospital and take referrals from other hospitals.
The clinic is different from the regular Anticoagulation clinics that are usually run by pharmacists ornurses and that do just INR monitoring and then adjust anticoagulation doses. The DAC is structured to meet the needs of our Centre and so is directed by trained Physicians who assess patients to makediagnosis and then place patients on appropriate anticoagulants. The DAC also manages any complications arising from anticoagulation. The clinic also has a submit that manages Pulmonary embolism, made up of Cardiologists, Cardiothoracic Surgeons, Hematologists, ICU nurses and clinical Pharmacists.

i. Patients with venous thromboembolism.
ii. Patients with mechanical heart values.
iii. Patients with atrial fibrillation.
iv. Other patients with cardiomyopathy, heart failure with dilated heart chambers, antiphospholipid syndrome etc.

The clinic will be run by Consultant Cardiologists and Hematologist and supported by

  1. Pharmacists
  2. Nurses
  3. Dieticians
  4. Medical record staff


The Cardiologist and the Hematologist will access patients and prescribe anticoagulant therapies. They will also outline any clinical and laboratory monitoring as well as manage patients who0 have complications. The Hematologists will in addition ensure that all INR machines are serviced and maintained at optimal level. Quality control of the results will be at two levels: internal, weekly, with main laboratory machines and external, monthly with a standard private laboratory in Enugu.


The pharmacist and the nurses will provide a continuation service for all patients already assessed by the consultants. The pharmacists will also advice on drug use and drug availability.
The dieticians will provide derailed dietary information and advice the patient on diets.
The consultants will take into account all changes in diets and any drug-food and drug-drug interaction.

The medical record officers will document all activities of all the Centre and will be required to provide an electronic platform for interaction and communication with staff, patients and referral sources. All results should be accessible from virtually anywhere, anytime.

The unit holds regular seminars to improve and add on to their ability to deliver world class service.
In principle, the UNTH DEDICATED ANTICOAGULATION CLNIC runs on Tuesdays in the medical outpatients unit, by 12noon. So, referrals will be to DEDICATED ANTICOAGULATION CLNIC. The patients so referred are assessed to make sure they need anticoagulation and prescribe the right anticoagulant. The clinic will also take referrals for admitted patients who need proper anticoagulation.
The clinic has now started a daily service (Mondays, Wednesdays, Thursdays, Fridays) from 12noon and will provide a refill for patients already on anticoagulants. The daily clinic will be run by Pharmacists and nurses and will also register patients who are referred from other clinics who will need to be assessed by consultants on Tuesdays.
The clinic is pioneered and directed by Dr Ralph Anakwe.

The Centre works with already established relevant American and European Societies of Anticoagulation Hematology and Cardiology guidelines. There is a detailed standard of practice (SOP) that guide the day to day service of our UNTH DAC. The Centre documents all relevant findings with a view to establishing any peculiarities in anticoagulation among our population.
The clinic is in charge of anticoagulation with all medications including the new oral anticoagulants. No doubt, warfarin is still anticoagulant that requires monitoring, but the new anticoagulants are still evolving and it is in keeping with established rules that the clinic monitors all patients on all anticoagulants. This will improve our understanding of all anticoagulants and their unique properties.

Dr Ralph Anakwe (08033343044)-Consultant Cardiologist & Clinical Pharmacologist.



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