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The Dorset Formulary has been developed in associations with
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Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust		  
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Chapter review date:
 Details...
02.08.02  Expand sub section  Oral anticoagulants
 note 

See bottom of section for commissioning statements and guidance covering multiple oral anticoagulants
Warfarin
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Green

Indicated for prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation;prophylaxis after insertion of prosthetic heart valve; prophylaxis and treatment of venous thrombosis and pulmonary embolism

 
  • RBCH and DCHFT: 5mg tablets not stocked.
 
Link  Primary Care management of high INR July 2017
   
Apixaban (Eliquis®)
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Red

  • In accordance with NICE TA for prevention of VTE in patients undergoing hip or knee replacement surgery, as per licensed indications.
    • Note routine 1st line option at RBCH and DCH is LMWH


Green

  • For prevention of stroke or systemic embolism in patients with AF within NICE TA and local guidance, as per licensed indications.
  • For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with NICE TA. 

 

 
Link  NICE TA 245:Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
Link  NICE TA 275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
Link  NICE TA 341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Dabigatran (Pradaxa®)
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Red

  • In accordance with NICE TA for prevention of VTE in patients undergoing hip or knee replacement surgery, as per licensed indications.
    • Note routine 1st line option at RBCH and DCH is LMWH

Green

  • For prevention of stroke or systemic embolism in patients with AF within NICE TA and local guidance, as per licensed indications.
  • For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with NICE TA. 

 

 
Link  NICE TA 157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
Link  NICE TA 327:Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Link  NICE TA 249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
   
Edoxaban (Lixiana®)
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Green

  • For prevention of stroke or systemic embolism in patients with AF within NICE TA and local guidance, as per licensed indications.
  • For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with NICE TA. 

 

 
Link  NICE TA 354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
Link  NICE TA 355: Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation
   
Rivaroxaban (Xarelto®)
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Red

  • Prophylaxis in Superficial Thrombosis - refer to Anticoagulation policy. 6 week course unlicensedUnlicensed
  • In accordance with NICE TA for prevention of VTE in patients undergoing hip or knee replacement surgery, as per licensed indications.
    • Note routine 1st line option at RBCH and DCH is LMWH


Amber 

  • Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome. As per NICE TA335.
    • For initiation by Consultant Cardiologist only. See shared care guideline for further details. 


Green

  • For prevention of stroke or systemic embolism in patients with AF within NICE TA and local guidance, as per licensed indications.
  • For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism in accordance with NICE TA.
 
Link  NICE TA 170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
Link  NICE TA 335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
Link  Commissioning statement for the use of rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
Link  Shared care guideline for the use of rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
Link  NICE TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Link  NICE TA 261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Link  NICE TA 287:Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
   
Acenocoumarol (Sinthrome®)
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Amber 		Tablets.
  • Specialist initiation in patients intolerant of warfarin (where other oral agents are not indicated).

    •  
       
    Phenindione
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    Amber     		Tablets.
  • Specialist initiation.
    •  
       
     link Link    Direct Acting Oral Anticoagulants (DOACs) in Renal Impairment : Practice Guide To Dosing Issues
     link Link    RBH Electronic (publisher) version of Direct Oral Anticoagulant (DOAC) Alert Card
     link Link    DCH Electronic (Publisher) version of Direct Oral Anticoagulant (DOAC) Alert Card
     link Link    Primary Care Treatment of DVT (with NOAC) Pathway
     link Link    DCHFT Policy for prevention of venous thromboembolism (VTE) for adults
     link Link    DCHFT Venous thromboembolism guideline
     link Link    DCHFT: Emergency reversal of anticoagulation guideline
     link Link    Medicines Q&A Can small volume intramuscular injections be given to patients taking oral anticoagulants?
     link Link    Medicines Q&A Warfarin and PPI interactions
     link Link    PHT & RBCH Guidelines for Prevention and Treatment of VTE in Pregnancy
     link Link    RBCH Anticoagulation Guidelines
     link Link    RBCH VTE prevention guidelines
     link Link    RBH & PFT DOAC Initiation form 2019
     link Link    Stopping DOACs before procedures (2018)
    02.08.02  Expand sub section  Atrial Fibrillation
    02.08.02  Expand sub section  VTE Prophylaxis
     ....
    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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