[2014] 1.6.10 Reassess anticoagulation for a person whose anticoagulation is poorly controlled shown by any of the following: 2 INR values higher than 5 or 1 INR value higher than 8 within the past 2 INR values less than 1.5 within the past 6 months TTR less than 65%. [2014] 1.6.11 When reassessing anticoagulation, take into account and if possible address the following factors that may contribute to poor anticoagulation control: cognitive function adherence to prescribed therapy illness interacting drug therapy lifestyle factors including diet and alcohol consumption. [2014] 1.6.12 If poor anticoagulation control cannot be improved, evaluate the risks and benefits of alternative stroke prevention strategies and discuss these with the person. [2014] Self-monitoring and self-management of vitamin K antagonists NICE has developed diagnostics guidance on atrial fibrillation and heart valve disease: self-monitoring coagulation status using point-of-care coagulometers (the CoaguChek XS system). Antiplatelets For guidance on antiplatelet therapy for people who have had a myocardial infarction and are having anticoagulation, see antiplatelet therapy for people with an ongoing separate indication for anticoagulation in NICE's guideline on acute coronary syndromes. 1.6.13 Do not offer aspirin monotherapy solely for stroke prevention to people with atrial fibrillation. [2014] Review of people with atrial fibrillation 1.6.14 For people who are not taking an anticoagulant, review stroke risk when they reach age 65 or if they develop any of the following at any age: diabetes heart failure peripheral arterial disease coronary heart disease stroke, transient ischaemic attack or systemic thromboembolism. [2014] 1.6.15 For people who are not taking an anticoagulant because of bleeding risk or other factors, review stroke and bleeding risks annually, and ensure that all reviews and decisions are documented. 