Anticoagulation refers to the practice of using blood thinning drugs to prevent thrombosis such as stroke, heart attacks or deep vein thrombosis.
The commonest drug in use for this purpose in Malta is Warfarin. This drug requires regular blood monitoring in order to achieve best results. The usual way was to take a venous blood sample and send this to the laboratory for testing.
A more novel way is to use a point of care (POC), handheld machine which allows to do the same blood test using a droplet of blood from a finger prick applied to a test strip (similar to blood sugar monitoring). The latter service was first introduced in Malta in 2014 with the inspiration and leadership of Dr Christopher Barbara, Chairperson of Pathology at Mater Dei Hospital, the support from the Ministry of Health and the toil of the Point of Care testing team through Ms Stephanie Meli who led the training at 9 Health Centres dotted around Malta and Gozo.
The implementation of this project was no mean feat since it required a lot of specialised IT input. Once adopted, it required validation. The latter was carried out by Dr Nicoletta Riva as part of her PhD studies within the Department of Pathology, Faculty of Medicine & Surgery, University of Malta, under the supervision of Prof. Alex Gatt.
Through a collaboration with the Coagulation Laboratory at Mater Dei Hospital, Dr Riva first started by proving that the results obtained by the newer system were at least as good as the current laboratory standard.
In the paper published in the International Journal of Laboratory Haematology, she demonstrated that this is not only the case but that it could be that the POC method might be slightly more accurate. She then looked at whether the patients using these new clinics were satisfied with the service provided. However, at that point in time, there weren’t any anticoagulation Quality of Life (QOL) tools validated in the Maltese language. Dr Riva validated 2 questionnaires (ie the PACT-Q and the DASS) by interviewing patients both in English and Maltese. This work was published in Psychology Research and Behavior Management and Patient Preference and Adherence journals.
With the tools validated, Dr Riva used these questionnaires to verify the QOL of the local POC population when compared to the standard laboratory testing method. Her results showed that people attending these POC clinics suffer less hassles and burdens of care than others attending the hospital Anticoagulation Clinic. This work has been accepted for publication in Blood Transfusion journal.
This project has also yielded important collaborations with various foreign institutions, namely the University of Sheffield through Prof Michael Makris where Dr Riva performed some of her laboratory work, the University of Insubria through the collaboration with Prof Walter Ageno and also the University of Leeds through Prof. Robert Ariens.
Dr Riva’s work has been presented at various international and national conferences. More importantly her work has proven that a new service introduced for more than 1.5% of the Maltese population is both accurate and well received by the clients themselves!