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 Formulary Chapter 2: Cardiovascular system - Full Chapter
02.08.02  Expand sub section  Oral anticoagulants
Acenocoumarol
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Restricted Drug Restricted
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Secondary care notes

  • NMUH approvals:
    • Restricted for patients allergic to Warfain only.
    • Check MHRA Drug Safety Updates
  • RFL approvals:
    • Not applicable
  • RNOH approvals:
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
Apixaban
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Formulary
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See NICE TA for eligibity criteria

Secondary care notes

  • NMUH approvals:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • See links below
    • Check MHRA Drug Safety Update
    • A referral form must be completed by Authorised Teams/ Haematology team to initiate a DOAC
    • A GP notification form must be completed and sent to the GP for each patient newly started on a DOAC
    • A copy of the above forms (referral form and GP notification form) must be sent to the anticoagulant clinic
  • RFL approvals:
    • Not applicable
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • 2nd Choice DOAC - For Atrial Fibrillation / Stroke prevention.
 
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support)
Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
Link  NICE TA275: Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Link  NMUH: Trust Guideline on the Management of Suspected and Confirmed Venous Thromboembolism in Adult Inpatients
   
Dabigatran
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Restricted Drug Restricted
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See NICE TA for eligibity criteria

Secondary care notes

  • NMUH approvals:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • Restricted for thromboprophylaxis post elective total hip or knee replacement surgery and emergency hip fracture surgery, as per Trust guidelines.
    • See links below
    • Check MHRA Drug Safety Updates
    • A referral form must be completed by Authorised Teams/ Haematology team to initiate a DOAC
    • A GP notification form must be completed and faxed to the GP for each patient newly started on a DOAC
    • A copy of the above forms (referral form and GP notification form) must be sent to the anticoagulant clinic
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Restricted for use as thromboprophylaxis after elective hip and knee surgery
 
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support)
Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism (VTE) after hip or knee replacement surgery in adults
Link  NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
Link  NMUH: Trust Guideline on the Management of Suspected and Confirmed Venous Thromboembolism in Adult Inpatients
Link  NMUH: Trust Guidelines on ’The Use of Dabigatran for Oral Thromboprophylaxis in Adults after Elective Hip & Knee Replacement Surgery and Emergency Hip Fracture Surgery’
   
Edoxaban
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Restricted Drug Restricted
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See NICE TA for eligibity criteria

Secondary care notes

  • NMUH approvals:
    • Positive NICE TA - This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • A referral form must be completed by Authorised Teams/ Haematology team to initiate a DOAC
    • A GP notification form must be completed and sent to the GP for each patient newly started on a DOAC
    • A copy of the above forms (referral form and GP notification form) must be sent to the anticoagulant clinic
  • RFL approvals:
    • Not applicable
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Not to be used for initiation of therapy.
 
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support)
Link  NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism
Link  NICE TA355:Edoxaban for preventing stroke/systemic embolism in non‑valvular atrial fibrillation
Link  NMUH: Trust Guideline on the Management of Suspected and Confirmed Venous Thromboembolism in Adult Inpatients
   
Phenindione
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Restricted Drug Restricted
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Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Should only be used in patients who are allergic to warfarin.
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
   
Rivaroxaban
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Restricted Drug Restricted
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Secondary care notes

  • NMUH approvals:
    • Positive NICE TA This medicine has a positive NICE Technology Appraisal and is listed in the Trust Medicines Formulary when used in line with NICE recommendations and/or Local Trust Guidelines.
    • For thromboprophylaxis for patients immobilised with lower limb plaster casts. Patient must have had a risk assessment for VTE and must receive the Trust Rivaroxaban Information for Patients leaflet (see links below).
    • Restricted to Haematologists only
    • Check MHRA Drug Safety Updates
    • A referral form must be completed by Authorised Teams/ Haematology team to initiate a DOAC
    • A GP notification form must be completed and sent to the GP for each patient newly started on a DOAC
    • A copy of the above forms (referral form and GP notification form) must be sent to the anticoagulant clinic
    • see links below
  • RFL approvals:
    • Under haemophilia approval for treatment of DVT only
  • RNOH approvals:
    • Nil
  • UCLH approvals:
  • WH approvals:
    • 1st Choice - For Atrial Fibrillation / Stroke prevention.
 
Link  NCL JFC: DOAC support documents (referral, counselling checklist, GP communication, prescribing support, interactions)
Link  NCL JFC: Summary of antiplatelet options in cardiovascular disease
Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
Link  NICE TA261: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Link  NICE TA265: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Link  NICE TA287: Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome
Link  NMUH: Risk Assessment Form for VTE for patients immobilised with lower limb casts
Link  NMUH: Rivaroxaban Information for Patients leaflet
Link  NMUH: Trust Guideline on the Management of Suspected and Confirmed Venous Thromboembolism in Adult Inpatients
   
Warfarin
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Formulary
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Secondary care notes

  • NMUH approvals:
    • See links below
    • Check MHRA drug safety update
  • RFL approvals:
    • See links below
  • RNOH approvals
    • Nil
  • UCLH approvals:
  • WH approvals:
    • Nil
 
Link  NMUH: Trust Guideline on the Management of Suspected and Confirmed Venous Thromboembolism in Adult Inpatients
Link  RFL: Protocol for Reversal of Warfarin Anticoagulation
Link  RFL: Warfarin initiation and maintenace
   
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
 ....
 Non Formulary Items
Apixaban
(VTE prophylaxis in cancer)

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Non Formulary
GP - Red

Approved for (JFC January 2019):

  • Multiple myeloma starting chemotherapy with thalidomide, lenalidomide or pomalidomide who would previously have received LMWH
  • Newly diagnosed multiple myeloma with additional VTE risk factor

Dose is 2.5mg twice-daily.

 

Secondary care notes

  • NMUH approvals:
    • Not applicable
  • RFL approvals:
    • Not applicable
  • RNOH approvals
    • Not applicable
  • UCLH approvals:
  • WH approvals:
    • Not applicable
 
Rivaroxaban
(VTE prophylaxis in cancer)

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Non Formulary
Black

Not recommended for thromboprophylaxis during neo-adjuvant chemotherapy prior to elective interval debulking surgery or stage III & IV primary epithelial ovarian cancer (JFC October 2018)

 
  
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
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

GP - 1st

Medicines suitable for first-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - 2nd

Medicines suitable for second-line use within primary care.

Can be initiated within primary care within their licensed indication, in accordance with nationally recognised formularies, for example the BNF, BNF for Children, Medicines for Children or Palliative Care Formulary. Primary care prescribers take full responsibility for prescribing. 

  

GP - Amber

Medicines that should be initiated by a specialist. Prescribing can be transferred to primary care once the patient has been stabilised.  

Shared care: For drugs with regular, ongoing need for monitoring and/or assessment of efficacy or toxicity. Prior agreement must be obtained by the specialist from the primary care provider before prescribing responsibility is transferred. The shared care protocol must have been agreed by the relevant secondary care trust Drugs and Therapeutics Committee(s) (DTC) and approved by the North Central London JFC.

Fact sheet: For drugs with some concerns surrounding safety or efficacy but do not require regular monitoring and/or monitoring of effectiveness/toxicity.

  

GP - Red

Medicines which should normally be prescribed by specialists only (hospital only).

For patients already receiving prescriptions in primary care - continue. No new patients to receive prescriptions in primary care.

  

GP - Grey

Medicines on hospital formularies which have not been reviewed for suitability in primary care.  

Black

Medicines not recommended for routine use in primary or secondary care.

Medicines, which the North Central London JFC has actively reviewed and does not recommend for use at present due to limited clinical and/or cost effective data.

  

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