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2.8.2 Oral anticoagulants

2.8.2 Oral anticoagulants

 2.8.2 Prescribing Guidance for oral anticoagulants

Click here to  Access Guidelines and Leaflets

Rapid reversal of anticoagulant effects of dabigatrtan - [click here]


2.8.2 Oral anticoagulants

           AMBER        Warfarin tablets 1mg, 3mg, 5mg
           AMBER        Acenocoumarol (nicoumalone) tablets 1mg (Sinthrome®)
 
         Novel oral anticoagulants (NOACs)      
           These drugs are relatively new to the market and the potential long‐term side effects are not yet fully known. Concerns also
           include that the optimal method of emergency reversal of the anticoagulant effects for all these agents is currently unclear
           in those patients who present with major bleeding. There are also concerns, highlighted by the MHRA regarding dabigatran
           use in renal insufficiency as exposure is substantially increased in these patients. The benefits of dabigatran and rivaroxaban
           over warfarin decline as INR control on warfarin increases. In patients where warfarin is well controlled (time in therapeutic
           range [TTR] >65%), the use of dabigatran or rivaroxaban may be less favourable.  On this basis, the use of these drugs should
           be implemented carefully and targeted to those patients that are likely to gain the most benefit from them  i.e. patients
           poorly controlled on warfarin or those eligible for, but choose not to be anti coagulated with warfarin. 
 
           An alert card is available in ELHE to clearly inform patients and healthcare professionals of key safety information regarding 
           the use of novel oral anticoagulants. All patients should be issued with this card.
 
           Prevention of stroke and systemic embolism in atrial fibrillation 
           GREEN         Dabigatran capsules 110mg, 150mg                     NICE guidance TA249  
           GREEN         Rivaroxaban tablets 15mg, 20mg                            NICE guidance TA256

           Prevention of stroke and systemic embolism in non-valvular atrial fibrillation
           GREEN         Edoxaban tablets 15mg, 30mg, 60mg                    NICE  guidance TA355 
           GREEN          Apixaban tablets  2.5mg, 5mg                           NICE guidance TA275

           Prevention of venous thromboembolism after total hip or knee replacement in adults
           GREEN            Apixaban tablets  2.5mg                                            NICE guidance TA245
           GREEN            Rivaroxaban tablets 10mg                                        NICE guidance TA170
           GREEN             Dabigatran capsules 75mg, 110mg, 150mg           NICE guidance TA157
 
           Pulmonary embolism and preventing recurrent venous thromboembolism
           GREEN        Rivaroxaban tablets 15mg, 20mg                          NICE guidance TA287 
 
           Deep vein thrombosis (DVT) and prevention of recurrent DVT and pulmonary embolism
           GREEN         Rivaroxaban tablets 15mg, 20mg                              NICE  guidance TA261
 
           Prevention of atherothrombotic events in people with coronary or peripheral artery disease
           AMBER        Rivaroxaban 2.5mg [plus aspirin]                             NICE guidance TA607
                              [duration of treatment 12 months and then to be reviewed]
 
          Deep vein thrombosis (DVT) and pulmonary embolism (PE) , and extended prevention of current DVT and PE in adults
          after initial treatment. 
          Rivaroxaban 10mg is recommended for treatment of Deep Venous thrombosis and Pulmonary Embolism, and extended
          prevention of recurrent DVT and PE in adults.
          When extended prevention of recurrent DVT and PE is indicated (following completion of at least 6 months therapy for DVT
          or PE), the recommended dose is 10 mg once daily. In patients in whom the risk of recurrent DVT or PE is considered high,                 such as those with complicated comorbidities, or who have developed recurrent DVT or PE on extended prevention with
          rivaroxaban 10 mg once daily, a dose of rivaroxaban 20 mg once daily should be considered. The duration of therapy and
          dose selection should be individualised after careful assessment of the treatment benefit against the risk of bleeding.

 

 

Time period

Dosing schedule

Total daily dose

Treatment and prevention of DVT and PE

 

Day 1 -21 

15mg twice daily

30mg

Day 22 onwards 

20mg once daily

20mg

Prevention of recurrent DVT and PE*

Following completion of at least 6 months therapy for DVT or PE

10mg once daily (20mg once daily if considered high risk of recurrent DVT/PE)

See guidance

10mg 

 
          * recommendation or initiation by a specialist
          AMBER        Rivaroxaban 10mg tablets
 
          Deep vein thrombosis and/or pulmonary embolism - treatment and secondary prevention
          GREEN         Dabigatran capsules 110mg, 150mg                        NICE  guidance TA327  
          GREEN         Apixaban tablets 2.5mg , 5mg                                   NICE guidance TA341 
 
          Treatment and prevention of recurrent Deep vein thrombosis or pulmonary embolism 
          GREEN         Edoxaban tablets 15mg, 30mg, 60mg                    NICE  guidance TA354. 
 
          Prevention of adverse outcomes after acute management of acute coronary syndrome
          GREEN          Rivaroxaban  tablets 2.5mg                                     NICE guidance TA335
 
          Clinicians should consult the summary of product characteristics for further advice. Both products are likely to be used  
          initially for patients requiring extended prophylaxis following discharge, or in patients with needle phobia. All supplies will be
          prescribed and dispensed by the hospital, and GPs should not be asked to pick up or continue prescribing for these agents.
          Neither agent requires any anti-coagulant monitoring.






 
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members of the public seeking advice on medicine-related matters are advised to speak with their GP,
 pharmacist, nurse or contact NHS111 Service

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