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Dorset
The Dorset Formulary has been developed in associations with
NHS Dorset Clinical Commissioning Group
Dorset County Hospital NHS Foundation Trust
Dorset Healthcare University NHS Foundation Trust
University Hospitals Dorset NHS Foundation Trust
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Chapter review date:

 Details...
02.08.01  Expand sub section  Parenteral anticoagulants
Argatroban (Exembol®)
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Formulary
Red

For treatment of Heparin-Induced Thrombocytopaenia (HIT)in critically unwell patients or those with severe renal impairment on advice of Consultant Haematologist.

 
 
02.08.01  Expand sub section  Heparin
Heparin
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Formulary
Red
Injection.
  • RBCH: 5000unit in 0.2mL for SC use; 20 000unit in 20mL for IV infusion.
  • DCHFT:
    Heparin calcium 5000 units in 0.2mL.

    Heparin sodium 200 units in 2mL - Renal use only.
    Heparin sodium 5000 units in 5mL - Renal use only.
    Heparin sodium 25000 units in 5mL - Renal use only.

    Heparin sodium (for syringe pump) 1000 units per mL (10mL vial).
    Heparin sodium (for syringe pump) 1000 units per mL (20mL vial).

    Heparin sodium 1000 units per mL (1mL vial).
    Heparin sodium 5000 units per mL (1mL vial).

    Heparin sodium 10 units per mL (5mL vial). Restricted Item  Heparin flush restricted for CVP lines only.
  •  
    Link  DCHFT Guideline For Anticoagulation With Conventional (Unfractionated) Intravenous Heparin.
    Link  DCHFT Peritoneal dialysis: Adding heparin to a bag of dialysate in advance
    Link  DCHFT Peritoneal dialysis: Adding IP heparin to a bag of dialysate for APD (Automated Peritoneal Dialysis) – Supplementary Advice. Nursing Staff Only.
    Link  DCHFT Peritoneal dialysis: Adding IP heparin to a bag of dialysate in order to prevent blockage of the tenckhoff catheter by fibrin for CAPD
     
    02.08.01  Expand sub section  Low molecular weight heparins
    Enoxaparin (Inhixa® (biosimilar) or Clexane®)
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    First Choice
    Green

    Two brands are available: Inhixa® and Clexane®.


    Enoxaparin -Inhixa® is the preferred brand in Dorset.


    Enoxaparin should be BRAND PRESCRIBED and patients should be maintained on the same brand where possible. If a need to switch arises (e.g during shortages) patients should be appropriately counselled on device differences.



    Green for DVT in patients who are intravenous drug users.

    Amber for use in accordance with the relevant local shared care guidance.


    Red for specialist indications, e.g. prevention of clotting in the extracorporeal circuit during haemodialysis, not listed above





     

     
    Dalteparin (Fragmin®)
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    Formulary

    Green for DVT in patients who are intravenous drug users.


    Specialist initiation:


    Amber Please use in accordance with the relevant local shared care guidance.


    Red for specialist indications, e.g. prevention of clotting in the extracorporeal circuit during haemodialysis, not listed above.


     


     

     
    Link  FAQs about LMWHs
    Link  Shared Care Guideline for the use of LMWH drugs in adult patients July 2020
    Link  Shared care guidelines for LMWH for the treatment of Venous Thromboembolism in cancer patients
    Link  NICE NG158 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
    Link  Shared care guidelines for dalteparin for Salisbury only
     
    Tinzaparin ((Innohep®))
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    Formulary

    Green categorisation for DVT in patients who are intravenous drug users.


    Specialist initiation.



    Amber please use in line with local shared care guidelines


    Red Restricted Item Poole Dialysis unit: Restricted for haemodialysis extracorporeal circuits only.

     
    Link  NICE NG158 Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
    Link  Shared Care Guideline for the use of LMWH drugs in adult patients July 2020
    Link  Shared care guidelines for LMWH for the treatment of Venous Thromboembolism in cancer patients
     
    02.08.01  Expand sub section  Heparinoids
    Danaparoid (Orgaran®)
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    Formulary
    Red
    Injection.
    For consultant use only on haematological advice. 
     
    02.08.01  Expand sub section  Hirudins to top
    Bivalirudin (Angiox®)
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    Formulary
    Red
    Injection.
  • Cardiology use only in accordance with NICE TA230.

  • See commissioning statement for bivalirudin.
  • DCHFT: Consultant use only, in accordance with NICE TA230 (ST elevated myocardial infarction) or for anticoagulant patients who develop heparin induced thrombocytopeania (HIT).
  •  
    Link  Commissioning Statement for Bivalirudin for the treatment of ST-segment-elevation myocardial infarction
    Link  NICE NG185 Acute coronary syndromes (Previously NICE TA230)
     
    02.08.01  Expand sub section  Heparin flushes
    Heparinised saline flush
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    Formulary
    Red

    Heparin sodium 10 units per mL (5mL vial).
    Specialist initiation.



    • DCHFT: Restricted Item Heparin flush restricted for CVP lines only.


     

     
     
    02.08.01  Expand sub section  Epoprostenol
    Epoprostenol (Flolan®)
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    Formulary
    Red
    High Cost Medicine
    Injection.
  • Commissioned by NHS England for PAH, as per NHS England policy A11/PS/b.
  • Used for anticoagulant in dialysis circuits and CVVH (included in tariff).

  •  
    Link  Commissioning Policy: Targeted Therapies for use in Pulmonary Hypertension in Adults
     
    02.08.01  Expand sub section  Fondaparinux
    Fondaparinux (Arixtra®)
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    Formulary
    Red
    Injection.
  • Treatment of unstable angina or non-ST-segment elevation myocardial infarction (i.e. Acute Coronary Syndrome.

  • RBCH: Treatment option for Muslim patients not wishing to be treated with LMWH (porcine derived) for VTE treatment or prevention.
  •  
    Link  DCHFT Acute Coronary Syndrome (ACS) guidelines
     
     ....
     Non Formulary Items
    Bemiparin

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    Non Formulary
      
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Green

    May be initiated, stabilised and maintained in primary, secondary or tertiary care  

    Amber

    Amber drug - without shared care  

    Amber SCG

    Amber drug - with shared care guideline  

    Red

    For secondary or tertiary care initiation and long-term maintenance of prescribing  

    Black

    Not recommended  

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