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Kings College Hospital NHS Foundation Trust
Lewisham and Greenwich NHS Trust
 
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 Formulary Chapter 2: Cardiovascular system - Full Chapter
Notes:

Where a formulary entry does not detail a medicine’s indications for use, the medicine can be assumed to be approved for all licensed indications.

Formulary approved "off-label" use is detailed separately.

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02.08.02  Expand sub section  Oral anticoagulants
Edoxaban tabs (to prevent AF related stroke)
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Formulary
Amber 2

Edoxaban is the preferred DOAC to prevent AF related stroke

See APC Position Satement on preferred DOACs in SE London (link below)

 
Link  SE London APC prescribing guidance: Edoxaban for AF
Link  NICE TA355: Edoxaban for thromboprohylaxis in non-valvular AF
Link  Edoxaban - manufacturer’s patient support materials for use in stroke prevention in AF
   
Rivaroxaban tabs (treatment and prophylaxis of VTE)
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Formulary
Amber 3

Rivaroxaban is the preferred DOAC for the treatment and prophylaxis of VTE

See APC Position Satement on preferred DOACs in SE London (link below)

See links at the end of the section for initiation of treatment and transfer of care documents for DOACs in VTE

 
Link  SE London prescribing guidance: Rivaroxaban for VTE
Link  NICE TA261: Rivaroxaban for the treatment of DVT and prevention of recurrent DVT and/or PE
Link  NICE TA287: Rivaroxaban for treating PE and preventing recurrent VTE
Link  Rivaroxaban - manufacturer’s patient brochures (several languages)
   
Apixaban tabs  (to prevent AF related stroke)
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Formulary
Amber 2

Note that edoxaban is the preferred DOAC to prevent AF related stroke

See APC Position Satement on preferred DOACs in SE London (link below)

First four weeks to come from specialist care

 
Link  SE London APC prescribing guidance - Apixaban for AF
Link  NICE TA275: Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban
Link  Apixaban for non-valvular AF - manufacturers patient information booklets (several languages)
   
Apixaban tabs (treatment and prophylaxis of VTE)
View adult BNF View SPC online
Formulary
Amber 3

Note that rivaroxaban is the preferred DOAC for the treatment and prophylaxis of VTE

See APC Position Satement on preferred DOACs in SE London (link below)

See links at the end of the section for initiation of treatment and transfer of care documents for DOACs in VTE

 
Link  SE London APC prescribing guidance - Apixaban for VTE
Link  NICE TA341: Apixaban for treatment and secondary prevention of DVT and/or PE
Link  Apixaban for non-valvular AF - manufacturers patient information booklets (several languages)
Link  Apixaban for venous thromboembolism - manufaturers patient information booklets (several languages)
   
Apixaban tabs (prevention of VTE after hip or knee replacement surgery)
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Formulary
Red

Approved as per NICE technology appraisal guidance (see links below)

 
Link  NICE TA245: Venous thromboembolism - apixaban (hip and knee surgery
   
Dabigatran caps (to prevent AF related stroke)
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Formulary
Amber 2

Note that edoxaban is the preferred DOAC to prevent AF related stroke

See APC Position Satement on preferred DOACs in SE London (link below)

First four weeks to come from specialist care

 
Link  SE London APC prescribing guidance: Dabigatran for AF
Link  NICE TA249: Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
   
Dabigatran caps (treatment and prophylaxis of VTE)
View adult BNF View SPC online
Formulary
Amber 3

Note that rivaroxaban is the preferred DOAC for the treatment and prophylaxis of VTE

See APC Position Satement on preferred DOACs in SE London (link below)

See links at the end of the section for initiation of treatment and transfer of care documents for DOACs in VTE

 
Link  SE London APC prescribing guidance: Dabigatran for VTE
Link  NICE TA327: Dabigatran for treatment and secondary prevention of DVT and/or PE
   
Dabigatran caps (prevention of VTE after hip or knee replacement surgery)
View adult BNF View SPC online
Formulary
Red

Approved as per NICE technology appraisal guidance (see links below)

 
Link  NICE TA157: Venous thromboembolism - dabigatran
   
Edoxaban tabs (treatment and prophylaxis of VTE)
View adult BNF View SPC online
Formulary
Amber 3

Note that rivaroxaban is the preferred DOAC for the treatment and prophylaxis of VTE

See APC Position Satement on preferred DOACs in SE London (link below)

See links at the end of the section for initiation of treatment and transfer of care documents for DOACs in VTE

 
Link  SE London APC prescribing guidance: Edoxaban for VTE
Link  NICE TA354: Edoxaban for treating and for preventing DVT and/or PE
Link  Edoxaban - manufacturer’s patient support material for use in VTE
   
Rivaroxaban tabs (prevention of atherothrombotic events after ACS)
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Formulary
Amber 3

Approved as per NICE technology appraisal guidance (see links below)

See links below for transfer of care documentation

 
Link  SE London prescribing guidance: Rivaroxaban for ACS
Link  Rivaroxaban for ACS: Notification of initiation to GP
Link  Rivaroxaban in ACS: Transfer of care to GP
Link  NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of ACS
Link  Rivaroxaban - manufacturer’s patient brochures (several languages)
   
Rivaroxaban tabs (to prevent AF related stroke)
View adult BNF View SPC online
Formulary
Amber 2

See APC Position Satement on preferred DOACs in SE London (link below)

First four weeks to come from specialist care

 
Link  SE London prescribing guidance: Rivaroxaban for AF
Link  NICE TA256: Rivaroxaban for thromboprophylaxis in AF
Link  Rivaroxaban - manufacturer’s patient brochures (several languages)
   
Rivaroxaban tabs (prevention of VTE after hip or knee replacement surgery)
View adult BNF View SPC online
Formulary
Red

Approved as per NICE technology appraisal guidance

 
Link  NICE TA170: Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults
   
Rivaroxaban tabs (preventing atherothrombotic events in people with coronary or peripheral artery disease)
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Formulary
Red

Approved as per NICE technology appraisal guidance (see links below)

 
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
Link  Rivaroxaban - manufacturer’s patient brochures (several languages)
   
Rivaroxaban tabs (superficial vein thrombosis - off-label)
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Formulary
Red

Approved off-label indication:

Superficial vein thrombosis, where the thrombosis is >5cm in length and >3cm of a junction with a deep vein (for clots closer to a deep vein, full VTE treatment should be given)

  • Dose = 10 mg daily for 6 weeks

See APC recommendation for further information (link below)

 
Link  SE London APC Recommendation: Rivaroxaban 10mg for the treatment of superficial vein thrombosis (SVT) in adults (off-label use)
   
Rivaroxaban tabs (heparin induced thrombocytopenia - off-label)
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Formulary
Red

Approved off-label indication:

As an option for Heparin Induced Thrombocytopenia (HIT) in stable patients at low risk of bleeding.  Usually started after initial management with parenteral therapy, e.g. argatroban.

  • Thrombosis team approval only
  • Usual dose for HIT without thrombosis = 15 mg twice daily until platelets >150x109/L and the patient is stable, followed by 20 mg daily (adjusted according to renal function). 
  • Usual dose for HIT complicated by thrombosis = 15 mg twice daily for 3 weeks followed by 20 mg daily (adjusted according to renal function).  Usual total course of 3 months.

See APC recommendation (link below) for further information

 
Link  SE London APC recommendation: Rivaroxaban for the treatment of heparin-induced thrombocytopenia (HIT) in adults (off-label use)
   
Rivaroxaban tabs (orthopaedic off label use)
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Formulary
Red

Approved off-label indication:

Thromboprophylaxis post pelvic ring/acetabular fracture as an alternative to Low Molecular Weight Heparin

Full course of up to 90 days to be prescribed and provided by the hospital.

Dose as per thromboprophylaxis post elective orthopaedic surgery (10mg daily)

See APC recommendation for further information (link below)

 
Link  SE London APC Recommendation: Rivaroxaban for thromboprophylaxis post pelvic ring fracture
   
Warfarin tabs
View adult BNF View SPC online
Formulary
Amber 2
 
   
Acenocoumarol tabs
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Formulary
Amber 2
 
   
Phenindione tabs
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Formulary
Amber 2
 
   
 ....
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

Traffic Light Status Information

Status Description

Red

Specialist or hospital prescribing only. The responsibility for prescribing, monitoring, dose adjustment and review should remain with the specialist or hospital. In very exceptional circumstances a specialist may discuss individual patient need for a RED drug to be prescribed by a GP and the GP should consider informing the Medicines Management team before a decision is made to prescribe for individual patients.   

Amber 1

Treatment can be initiated in primary care after a recommendation from an appropriate specialist  

Amber 2

Specialist initiation followed by maintenance prescribing in primary care  

Amber 3

Specialist initiation with ongoing monitoring required. After dose stabilisation GPs can be requested to take over prescribing responsibilities using the approved APC shared care documentation  

Green

Specialist and non-specialist initiation  

Grey

Not recommended for prescribing  

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