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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:
Unless explicitly stated, any brand names included in brackets next to a drug's generic name are there solely to aid searching and identification, and should not be considered to limit use to that specific brand.
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02.08.02  Expand sub section  Oral anticoagulants
 note 

Protocol for management of bleeding (and urgent reversal in case of need for emergency surgery) in patients on rivaroxaban (Xarelto®), apixaban (Eliquis®) or edoxaban (Lixiana®) - ANHSFT access only


Protocol for management of bleeding (and urgent reversal in case of need for emergency surgery) in patients on dabigatran (Pradaxa®) - ANHSFT access only



Warfarin versus novel oral anticoagulants (NOACS). How to choose? - British Heart Foundation

Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (aspirin, clopidogrel, dipyridamole, prasugrel, ticagrelor, dabigatran, rivaroxaban and apixaban) - ANHSFT access only

Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome (June 2019)

 

Dabigatran etexilate (Pradaxa®)
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Second Choice
Green
  • Dabigatran etexilate Capsules

Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) who meet the criteria of the West Yorkshire Cardiac Network. Use in-line with NICE.
 

Treatment and secondary prevention of DVT and PE in-line with NICE.

 
Link  NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation (March 2012)
Link  Drug Safety Update:Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
Link  MHRA Drug Safety Update: Dabigatran (Pradaxa▼): risk of serious haemorrhage (December 2014)
Link  MHRA Drug Safety Update: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼): risk of serious haemorrhage—clarified contraindications apply to all three medicines (September 2016)
Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
   
Idarucizumab injection (Praxbind®)
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Restricted Drug Restricted
Red
  • Idarucizumab Injection

For the urgent reversal of dabigatran etexilate.

The protocol for the management of bleeding, and urgent reversal in patients receiving dabigatran is available on AireShare.

 
Link  Protocol for the emergency reversal of bleeding in patients on dabigatran (ANHSFT Access only)
   
Rivaroxaban (Xarelto®)
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Formulary
Green
  • Rivaroxaban Tablets

Prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation in-line with NICE recommendations.
 

Treatment of DVT and the prevention of recurrent DVT and PE in adult patients, in-line with NICE guidance.

 
Link  Drug Safety Update: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
Link  Drug Safety Update: Rivaroxaban (Xarelto▼): reminder that 15 mg and 20 mg tablets should be taken with food (July 2019)
Link  Drug Safety Update: Rivaroxaban (Xarelto„) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial (October 2018)
Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or knee replacement surgery in adults (April 09)
Link  NICE TA256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation (May 2012)
Link  NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (July 2012)
Link  NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism (June 2013)
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after Acute Coronary Syndrome (March 2015)
Link  NICE TA607:Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease (October 2019)
Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
Link  MHRA Drug safety Update: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼): risk of serious haemorrhage—clarified contraindications apply to all three medicines (Sept 2016)
   
Apixaban (Eliquis®)
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Formulary
Green
  • Apixaban Tablets

Prevention of stroke and systolic embolism in patients with non-valvular atrial fibrillation in-line with NICE.
 

Treatment and prevention of DVT and or PE in line with NICE.

 
Link  Drug Safety Update: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
Link  NICE TA275: Apixaban for preventing stroke and systemic embolism in people with non-valvular atriall fibrillation (February 2013)
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (June 2015)
Link  NICETA 245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (January 2012)
Link  Perioperative management of anti-platelet and newer oral anticoagulants in patients undergoing elective procedures (ANHSFT access only)
Link  MHRA Drug Safety Update: New oral anticoagulants apixaban (Eliquis▼), dabigatran (Pradaxa) and rivaroxaban (Xarelto▼): risk of serious haemorrhage—clarified contraindications apply to all three medicines (Sept 2016)
   
Warfarin
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Formulary
Green
  • Warfarin Tablets
  • Warfarin Suspension - available by special order only
    Reserved for patients who are unable to swallow tablets.
 
Link  Pathway for Community Management of Warfarin Reversal
Link  Prescription and Administration Chart for ANHSFT Community care Teams
Link  Warfarin reversal guidelines (ANHSFT access only)
Link  MHRA Drug Safety Update: Warfarin: reports of calciphylaxis (July 2016)
Link  Perioperative management of oral anticoagulation in patients undergoing elective procedures (warfarin and other coumarins) (ANHSFT access only)
Link  UKMI QA: Is there an interaction between warfarin and proton pump inhibitors? (July 2015)
   
Edoxaban (Lixiana®)
View adult BNF View SPC online View childrens BNF  Track Changes
Formulary
Green
  • Edoxaban Tablets

Preventing stoke and systemic embolism in people with non-valvular atrial fibrillation in-line with NICE.
 

Treating and preventing deep vein thrombosis and pulmonary embolism in-line with NICE.

 
Link  Drug Safety Update: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, availability of reversal agents (June 2020)
Link  NICE TA354 - Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism (Aug 2015)
Link  NICE TA355 - Edoxaban for preventing stroke and systemic embolism in people with non‑valvular atrial fibrillation (Sept 2015)
   
 ....
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

Green - Drugs suitable for generalised use in accordance with position summary. Inform primary care of need to prescribe using a TTO chart if in patient or Treatment Advice Note (TAN) if Outpatient.   

Amber

Amber - these drugs require specialist initiation or recommendation  

Amber SCG

Amber Share Care - Drugs suitable for generalist use, in accordance with position summary, normally following specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Red

Red - Drugs for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

Red ULM

Red ULM - Unlicensed medicines for specialist use only, in accordance with position summary. GP’s should not be asked to prescribe these products.  

Grey

Grey drugs - No formal commissioning position. Check appropriate CCG /NHSE commissioning list or contact CCG/NHSE Medicines Management team for advice. Fill in individual funding request for appropriate CCG/NHSE. This will need to be signed by the Chief Pharmacist and a copy of the relevant DTC submission attached.   

Black

Black - Drugs not routinely commissioned so should not usually be prescribed  

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