| Formulary Chapter 2: Cardiovascular system - Full Chapter
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| 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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| Chapter Links... |
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| NICE NG106: Chronic heart failure in adults: diagnosis and management |
 SE London APC guidance: optimising therapy in chronic stable angina |
| SE London APC Guidance: Pharmacological management of Heart Failure |
| Details... |
| 02.08.02 |
Oral anticoagulants |
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Acenocoumarol tabs
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Formulary
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Apixaban tabs
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Formulary
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 For treatment and secondary prevention of DVT and PE, and thromboprophylaxis in AF.
See links at the end of the section for initiation of treatment and transfer of care documents
 (hospital only) For prevention of VTE after hip or knee replacement surgery
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SE London APC prescribing guidance - Apixaban for AF
SE London APC prescribing guidance - Apixaban for VTE
Jun 19 - MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
NICE TA245: Venous thromboembolism - apixaban (hip and knee surgery
NICE TA275: Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban
NICE TA341: Apixaban for treatment and secondary prevention of DVT and/or PE
Apixaban for non-valvular AF - manufacturers patient information booklets (several languages)
Apixaban for venous thromboembolism - manufaturers patient information booklets (several languages)
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Dabigatran caps
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Formulary
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For treatment and secondary prevention of DVT and PE, and thromboprophylaxis in AF
See links at the end of the section for initiation of treatment and transfer of care documents
(hospital only) For prevention of VTE after hip or knee replacement surgery
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SE London APC prescribing guidance: Dabigatran for AF
SE London APC prescribing guidance: Dabigatran for VTE
Jun 19 - MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
NICE TA157: Venous thromboembolism - dabigatran
NICE TA249: Dabigatran for Stroke prevention in AF
NICE TA327: Dabigatran for treatment and secondary prevention of DVT and/or PE
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Edoxaban tabs
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Formulary
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See links at the end of the section for initiation of treatment and transfer of care documents
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SE London APC prescribing guidance: Edoxaban for AF
SE London APC prescribing guidance: Edoxaban for VTE
Jun 19 - MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
NICE TA354: Edoxaban for treating and for preventing DVT and/or PE
NICE TA355: Edoxaban for thromboprohylaxis in non-valvular AF
Edoxaban - manufacturer’s patient support materials (several languages)
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Phenindione tabs
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Formulary
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Rivaroxaban tabs (licensed uses)
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Formulary
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For treatment and secondary prevention of DVT and PE, thromboprophylaxis in AF, and preventing adverse outcomes after acute management of ACS.
See links at the end of the section and below for initiation of treatment and transfer of care documents
(hospital only) For prevention of VTE after elective hip or knee replacement surgery
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 Rivaroxaban for ACS: Notification of initiation to GP
Rivaroxaban in ACS: Transfer of care to GP
SE London prescribing guidance: Rivaroxaban for ACS
SE London prescribing guidance: Rivaroxaban for AF
SE London prescribing guidance: Rivaroxaban for VTE
Jun 19 - MHRA Drug Safety Update: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome
NICE TA256: Rivaroxaban for thromboprophylaxis in AF
NICE TA261: Rivaroxaban for the treatment of DVT and prevention of recurrent DVT and/or PE
NICE TA287: Rivaroxaban for treating PE and preventing recurrent VTE
NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of ACS
Rivaroxaban - manufacturer’s patient brochures (several languages)
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Rivaroxaban tabs (superficial vein thrombosis - off-label)
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Formulary
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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)
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SE London APC Recommendation: Rivaroxaban 10mg for the treatment of superficial vein thrombosis (SVT) in adults (off-label use)
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Rivaroxaban tabs (orthopaedic off label use)
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Formulary
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 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)
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SE London APC Recommendation: Rivaroxaban for thromboprophylaxis post pelvic ring fracture
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Warfarin tabs
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Formulary
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Rivaroxaban tabs (hepain induced thrombocytopenia - off-label)
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Formulary
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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
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SE London APC recommendation: Rivaroxaban for the treatment of heparin-induced thrombocytopenia (HIT) in adults (off-label use)
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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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.
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Treatment can be initiated in primary care after a recommendation from an appropriate specialist |
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Specialist initiation followed by maintenance prescribing in primary care |
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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 |
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Specialist and non-specialist initiation |
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Not recommended for prescribing |
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