Warfarin is a competitive antagonist of vitamin K (phytomenadione), involved in the production of clotting factors. Its anticoagulant effect takes 36-48 hours to develop fully and is monitored using the international normalised ratio (INR). For treatment of VTE, heparin should continue for at least 5 days following warfarin initiation and not stopped until the INR has been in the therapeutic range for two consecutive tests.
There is currently no product available for the emergency reversal of apixaban, edoxaban or rivaroxaban
All patients discharged from hospital on anticoagulants should be referred to the UHL anticoagulant clinic for counselling.
Please be aware of the MHRA warning concerning DOACs and antiphospholipid syndrome
Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome is available for use by consultant cardiologists on request. Use only in line with NICE TA 335. Decision added June 16. Traffic light status is red for this indication.
For Atrial Fibrillation (AF) use inline with the Leicestershire Algorithms.
For patients with non-valvular AF, edoxaban is the preferred choice based on lower drug acquisition cost unless there is a specific clinical reason not to do so.
Date of entry of decision to formulary: November 2015
Drugs not recommended for use in the Leicestershire Health Community because of lack of evidence of clinical effectiveness, cost prioritization or concerns over safety.
All new drugs will be black until they have been through the appropriate approval process - then they will appear as a specific entry
Drugs which should be prescribed only by hospital specialists (clinical review by specialist as appropriate and annually as a minimum).
Drugs which would initially be prescribed by a hospital specialist and then by a GP where full agreement to share the care of each specific patient has been reached under a LMSG Shared Care Agreement (SCA). Specific patient monitoring or intervention required.
Drugs suitable to be initiated and prescribed in primary care only after specialist assessment and recommendation. A shared care agreement is not required.
Drugs for which GPs would normally take full responsibility for prescribing and monitoring. Drugs included in this list have been specifically considered by LMSG.
Drugs not yet reviewed
Drugs for which GPs are able to take full responsibility for prescribing and monitoring subject to specified conditions e.g. prescribing in line with agreed LMSG guidance or able to demonstrate suitable competence. See comments under individual entries