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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.08.02  Expand sub section  Oral anticoagulants
Apixaban (Eliquis)
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Link  NICE TA275: Apixaban for AF
   
Dabigatran (Pradaxa)
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Link  NICE TA249: Dabigatran for Stroke prevention in AF
   
Edoxaban (Lixiana)
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Link  NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular atrial fibrillation
   
Phenindione
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Restricted Drug Restricted  
   
Rivaroxaban (Xarelto)
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Link  NICE TA607:Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease (TA607)
   
Warfarin
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For all patients initiated on warfarin please ensure the anticoagulant service is informed.

For advice or referrals please call Telephone number 01484 355014

 

When in hospital INR checks should be done:

  • On admission
  • Prior to discharge
  • Daily during acute illness
  • 3 days after a dose change
  • After other medicines are changed; stopped or started.

 

For Slow Loading

 

If a patient does not require rapid initiation e.g. treatment of atrial fibrillation (AF) 2 to 3 mg daily can be given for 7 days then INR checked. (LMWH injections may not be necessary)

 

For inpatient dose adjustments: Loading doses

Rapid Loading dose: 5mg, 5mg, 5mg → INR on day 4

 

UNLESS: Fit young adults, patients > 100kg or if taking rifampicin, carbamazepine or phenytoin → 8mg, 8mg, 8mg

 

OR: Frail elderly or oncology patients → 3mg, 3mg, 3mg

 

 

For dose adjustments after 3 days loading dose use the below table

Target INR 2.5 (Range 2-3)

(Use table for predicting first dose following rapid loading)

INR

8mg, 8mg, 8mg

5mg, 5mg, 5mg

3mg, 3mg, 3mg

<1.5

7mg

5mg

3mg

1.8

6mg

4mg

2mg

2.0

5mg

3mg

1.5mg

2.2

4.5mg

3mg

1mg

2.5

4mg

3mg

1mg

3.0

3.5mg

2mg

0.5mg

3.5

3mg

-

-

4.0

3mg

-

-

 

 

 

For Dose reduction information

INR

Target INR 2.5

(Range 2.0 -3.0)

Target INR 3.5

(Range 3.0 -4.0)

% dose reduction

No. days dose omitted

% dose reduction

No. days dose omitted

3.0 - 3.5

15

Do not omit

-

-

3.6 - 4.0

20

-

-

4.1 - 5.0

25

15

 -

5.1 - 6.0

25

Omit for 1 day

20

Do not omit

6.1 - 8.0

33

Omit for 2 days

33

Omit for 2 days

>8.0

50

Omit for 3 days (check INR in the interim)

50

Omit for 3 days (check INR in the interim)

 

 

 
   
Acenocoumarol (Sinthrome)
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Restricted Drug Restricted

Restricted Item Information on restriction; only for use in patients allergic to warfarin

 
   
02.08.02  Expand sub section  Stroke prevention in AF
02.08.02  Expand sub section  VTE treatment
02.08.02  Expand sub section  VTE prophylaxis in hip/knee surgery
02.08.02  Expand sub section  Antidotes to top
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