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NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
Salisbury NHS Foundation Trust
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Cardiology-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

Cardiology-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 Details...
02.08.02  Expand sub section  Oral anticoagulants
 note 

Safe switching of warfarin to DOACs for patients with NVAF and VTE (DVT / PE) during the coronavirus pandemic 

PrescQipp anticoagulation resources including prescriber and patient decision aids, drug comparison charts

 Information on DOAC dosing in renal impairment https://www.sps.nhs.uk/wp-content/uploads/2019/07/DOAC-dosing-in-renal-impairment-vs2-July-2019-AW.pdf

MHRA DSU (Jun 2020) DOACs: reminder of bleeding risk, including availability of reversal agents

 MHRA Drug Safety Update (Jun 2019):DOACs: increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome

Apixaban (Eliquis®)
(Oral)
View adult BNF View SPC online
Formulary
  • Tablets 2.5mg, 5mg
  • The Traffic Light Status for apixaban depends on the prescribed indication:

  • Green Prevention of stroke and systemic embolism in NVAF. (TA275)
  • Green Treatment and secondary prevention of DVT and/or PE. (TA341)
  • Amber with Shared Care OFF-LABEL treatment of cancer associated thrombosis NOTE: Only for patients seen at the RUH. At other trusts, this would be a RED TLS indication currently. See SCA below.
  • Red Prevention of VTE after elective hip or knee replacement. (TA245) 
  • RedFollowing total hip replacement 2.5mg BD for 28 days post op then stop.
  • RedFollowing knee replacement 2.5mg BD for 14 days post op then stop.
 
Link  SCA: DOACS for the OFF-LABEL treatment of cancer associated thrombosis RUH PATIENTS ONLY
Link  NICE TA245: Prevention of VTE after elective hip or knee replacement
Link  NICE TA275: Prevention of stroke and systemic embolism in people with nonvalvular AF
Link  NICE TA341 Treatment and secondary prevention of DVT and/or PE
   
Dabigatran (Pradaxa®)
(Oral)
View adult BNF View SPC online
Formulary
  • Capsules 110mg, 150mg
  • The Traffic Light Status for dabigatran depends on the prescribed indication:

  • Green Prevention of stroke and systemic embolism in NVAF. (TA249)
  • Green Treatment and secondary prevention of DVT and/or PE. (TA327)
  • Red Prevention of VTE after elective hip or knee replacement. (TA157)
 
Link  NICE TA249: Prevention of stroke and systemic embolism in people with nonvalvular AF
Link  NICE TA327: Treatment and secondary prevention of DVT and/or PE
Link  MHRA DSU Dec 2014: Dabigatran (Pradaxa): contraindicated in patients with prosthetic heart valve(s) requiring anti-coagulant treatment
Link  MHRA DSU Dec 2014: Dabigatran (Pradaxa¥): risk of serious haemorrhage
Link  NICE TA157: Prevention of VTE after elective hip or knee replacement
   
Edoxaban (Lixiana®)
(Oral)
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Formulary
  • Tablets 15mg,30mg,60mg
  • The Traffic Light Status for edoxaban depends on the prescribed indication:
     
  • Green Prevention of stroke and systemic embolism in people with nonvalvular AF. (TA355) For NVAF, choice of DOAC should be based on individual patient characteristics. See here for example decision making tool. If clinically appropriate, edoxaban may be considered first line based on lowest acquisition cost. 
  • Green Treatment and secondary prevention of DVT and/or PE. (TA354)
  • Amber with Shared Care OFF-LABEL treatment of cancer associated thrombosis NOTE: Only for patients seen at the RUH. At other trusts, this would be a RED TLS indication currently. See SCA below.
 
Link  SCA: DOACS for the OFF-LABEL treatment of cancer associated thrombosis RUH PATIENTS ONLY
Link  NICE TA354: Treatment and secondary prevention of DVT and/or PE
Link  NICE TA355:Prevention of stroke and systemic embolism in people with nonvalvular AF
   
Rivaroxaban (Xarelto®)
(Oral)
View adult BNF View SPC online
Formulary
  • Tablets 20mg, 15mg, 10mg, 2.5mg. Note variation in the licensing of different strengths of rivaroxaban.
  • The Traffic Light Status for rivaroxaban depends on the prescribed indication:
  • Green Prevention of stroke and systemic embolism in people with nonvalvular AF. (TA256) 
  • Green Treatment and secondary prevention of DVT and/or PE . (TA261 and TA287)  
  • Green Co-administered with aspirin for the prevention of atherothrombotic events in adult patients with coronary artery disease (CAD) or symptomatic peripheral artery disease (PAD) at high risk of ischaemic events. (TA607) NOTE Only the 2.5mg tablet is licensed for this indication and the dose is 2.5mg BD
  • Amber Prevention of adverse outcomes after acute management of ACS with raised biomarkers. (TA335)  
  • Amber with Shared Care OFF-LABEL treatment of cancer associated thrombosis NOTE: Only for patients seen at the RUH. At other trusts, this would be a RED TLS indication currently. See SCA below.
  • Red Prevention of VTE after elective hip or knee replacement. (TA170)
 
Link  SCA: DOACS for the OFF-LABEL treatment of cancer associated thrombosis RUH PATIENTS ONLY
Link  NICE TA170: Prevention of VTE after elective hip or knee replacement
Link  NICE TA256: Prevention of stroke and systemic embolism in people with nonvalvular AF
Link  NICE TA261: Treatment and secondary prevention of DVT and/or PE
Link  NICE TA287: Treatment and secondary prevention of DVT and/or PE
Link  NICE TA335: Prevention of adverse outcomes after acute management of ACS with raised biomarkers
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
Link  MHRA reminder that 15 mg and 20 mg tablets should be taken with food
   
Warfarin 
(Tablet)
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Formulary
Green
  • 500 micrograms, 1mg, 3mg, 5mg
  • Splitting tablets can cause patients difficulties if necessary prescribe 500 microgram tabs
  • Use yellow books to record INR and dosage - see link below
  • INR self-testing & self-monitoring 
    • BaNES area - Self monitoring of warfarin using CoaguChek, or other devices, has NOT been approved in BaNES and test strips are NOT included in the formulary in this area.
    • Swindon & Wiltshire areas - Supply of Coaguchek test strips, on FP10 for home INR testing is generally appropriate if the patient discussed the purchase of their home INR testing device with their GP and/or the Anticoagulant Service prior to purchase, and this was agreed as appropriate. The patient should undergo a period of training and assessment with the Anticoagulant Service or their GP Practice. Please see Wiltshire CCG’s Advisory Summary on INR self-testing & self- monitoring for further details.

Guidance for safe switching of warfarin to direct oral anticoagulants (DOACs) for patients with non-valvular AF and venous thromboembolism (DVT / PE) during the coronavirus pandemic - see link below

 
Link  Guidance for the safe switching of warfarin to direct oral anticoagulants (DOACs) for patients with non-valvular AF and venous thromboembolism (DVT / PE) during the coronavirus pandemic
Link  Wiltshire CCG Advisory Summary: INR self-testing & self- monitoring (May 2017)
   
Phenindione 
(Tablet)
View adult BNF View SPC online
Alternatives
Green
  •  10mg, 25mg, 50mg (Very costly £538 for 28 tablets June 2019)
  •  Only for patients who are hypersensitive to warfarin.
 
   
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
 ....
 Non Formulary Items
Acenocoumarol (Sinthrome®)

View adult BNF View SPC online
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 SPCs
SMC
Scottish Medicines Consortium
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require 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.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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