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 Formulary Chapter 2: Cardiovascular system - Full Chapter
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02.08  Expand sub section  Anticoagulants and protamine
Idarucizumab (Praxbind®)
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Red

For the reversal of the anticoagulant effect of dabigatran.

APCO March 2016.

 
   
02.08.01  Expand sub section  Parenteral anticoagulants
Argatroban (Exembol®)
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Formulary
Red

Secondary care use only. 

 
   
02.08.01  Expand sub section  Heparin
Heparin
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Formulary
Red

Secondary care use only. 

 
   
02.08.01  Expand sub section  Low molecular weight heparins
Dalteparin (Fragmin®)
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In line with Dalteparin Guideline and Shared Care Protocol for Primary Care:

Amber Traffic Light  For sub-therapeutic INRs, DVT in patients with cancer, IV drug users & first doses in high risk of VTE in pregnancy.

Red Traffic Light  For perioperative anticoagulation, extended thromboprophylaxis & post-partum, trauma and intermediate risk of VTE in pregnancy.

Brown Traffic Light  For DVT & long haul flight prophylaxis.

APCO September 2016.

Brown Traffic Light For DVT (out of hours), in line with DVT service specification. Prescribe one off initial dose only if presentation of DVT outside of DVT clinic hours.

APCO September 2018.

Red Traffic Light For venous thromboprophylaxis for lower limb immobilisation. 

APCO July 2017.

Red Traffic Light First line for VTE prophylaxis in high risk covid-19 patients.

APCO January 2021.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

 
   
Tinzaparin (Innohep®)
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Black Traffic Light  For Oxfordshire patients. Dalteparin is LMWH of choice in Oxfordshire.

APCO September 2008.

Amber Traffic Light For South East locality patients referred by Royal Berkshire Hospital Foundation Trust ONLY. In line with Royal Berkshire Hospital Foundation Trust Shared Care Protocol.

APCO January 2014.

 
   
02.08.01  Expand sub section  Heparinoids to top
Danaparoid (Orgaran®)
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Red

Secondary care use only. 

 
   
02.08.01  Expand sub section  Hirudins
Bivalirudin (Angiox®)
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Red

For the treatment of ST-segment-elevation myocardial infarction as per NICE TA230.

 
Link  MHRA Drug Safety Update: Risks associated with incorrect dose
Link  NICE TA230 : Bivalirudin for the treatment of STEMI, 2011
   
02.08.01  Expand sub section  Heparin flushes
Heparin
(Flush)
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Formulary
Amber Continuation

Suitable for continuation in primary care following specialist initiation.

 
Link  UKMI Q&A: Heparin vs saline flushes for maintenance of patency in intravascular catheters & cannulae
   
02.08.01  Expand sub section  Epoprostenol
Epoprostenol (Flolan®)
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Red
High Cost Medicine

Specialist prescribing only.

Funded by specialised commissioning.

 
Link  MHRA: Incompatibilities between Veletri and some administration devices
   
02.08.01  Expand sub section  Fondaparinux
Fondaparinux (Arixtra®)
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Red

Secondary care use only. 

 
   
02.08.02  Expand sub section  Oral anticoagulants to top
Acenocoumarol (Sinthrome®)
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Green

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

 
   
Apixaban (Eliquis®)
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Green Traffic Light  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

Amber Traffic Light  For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO May 2015.

Brown Traffic Light For DVT (out of hours), in line with DVT service specification. Prescribe one off initial dose only if presentation of DVT outside of DVT clinic hours.

See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO September 2018.

Red Traffic Light  For preventing VTE after total hip or knee replacement in adults in line with NICE TA245.

APCO March 2012.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

 
Link  Apixaban - Manufacturer patient alert card
Link  Prescribing Points: Anticoagulation Special Edition
Link  NICE TA245: Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults
Link  NICE TA275: Apixaban for AF
Link  NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
CoaguChek Testing Strips
(INR self-testing)
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Restricted Drug Restricted
Brown

Restricted to patients who meet the following criteria:

  • To be on long-term oral anticoagulation.
  • To have sufficient eye sight to enable them to use the coagulometer.
  • To be sufficiently dextrous to carry out self-testing. (Training may be considered for patient carers or next of kin who meet the eye sight and dexterity criteria.)
  • To have GP support for the prescribing of strips.
  • To already be dosed by the Oxfordshire Anticoagulation Service (JR, Churchill or Horton hospitals).
  • To be able to afford the coagulometer (about £500 for the CoaguCheks and approximately £20 for enough quality control solutions for approximately one year, not including the training programme).

The patient would have to receive suitable training to carry out self-testing and this would normally be provided by the hospital anticoagulation service if self-testing is agreed appropriate.

 

APCO September 2018. 

 
   
Dabigatran (Pradaxa®)
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Green Traffic Light  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

Amber Traffic Light  For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO May 2015.

Red Traffic Light  For preventing VTE after total hip or knee replacement in adults in line with NICE TA157. 

APCO November 2008.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

 
Link  Dabigatran - Manufacturer patient alert card
Link  Prescribing Points: Anticoagulation Special Edition
Link  MHRA: Dabigatran - risk of serious haemorrhage
Link  MHRA: Dabigatran contraindicated in patients with prosthetic heart valve(s) requiring anti-coagulant treatment
Link  NICE TA157: Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults
Link  NICE TA249: Dabigatran for Stroke prevention in AF
Link  NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism
   
Edoxaban (Lixiana®)
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Green Traffic Light  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

Amber Traffic Light  For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE.

APCO January 2017.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

 
Link  Prescribing Points: Anticoagulation Special Edition
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  Risk minimisation resources
   
Phenindione
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Formulary
Green

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

 
   
Rivaroxaban (Xarelto®)
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Green Traffic Light  For preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation. See Primary Care Prescriber Decision Support for DOACs in Atrial Fibrillation.

APCO January 2017.

Amber Traffic Light 

  • For treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE (APCO May 2015).
  • For preventing adverse outcomes after acute management of acute coronary syndrome in line with NICE TA335. NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page (APCO May 2015).
  • For preventing atherothrombotic events in people with coronary or peripheral artery disease in combination with aspirin, as per NICE TA607 (APCO July 2020).

Brown Traffic Light 

  • For DVT (out of hours), in line with DVT service specification. Prescribe one off initial dose only if presentation of DVT outside of DVT clinic hours. See Guidelines for DOACs for Treatment and Secondary Prevention of VTE (APCO September 2018).
  • For superficial thrombophlebitis, second line to dalteparin in patients at intermediate risk (APCO January 2019).

 Red Traffic Light Second line for VTE prophylaxis in high risk covid patients.

APCO January 2021.

 
Link  Rivaroxaban - Manufacturer patient alert card
Link  Prescribing Points: Anticoagulation Special Edition
Link  MHRA Drug Safety Update: Rivaroxaban (Xarelto▼) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial
Link  NICE TA256: 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  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
Link  NICE TA607: Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
   
Warfarin
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Amber Shared Care Protocol

To be initiated in primary care for atrial fibrillation in line with Shared Care Protocol.

APCO March 2017.

NB. More information can be found on the OUHFT Anticoagulation & Thrombosis page.

 
Link  NPSA warfarin booklet
Link  Oral anticoagulant therapy patient booklets in different languages
Link  Prescribing Points: Anticoagulation Special Edition
Link  UKMI Q&A: IM injections in warfarin patients
Link  UKMI Q&A: Warfarin and PPI interaction
   
02.08.03  Expand sub section  Protamine sulphate
Protamine Sulphate
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Formulary
Red

Secondary care use only. 

 
   
 ....
 Non Formulary Items
Burinex K®

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Non Formulary
 
Centyl K®

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Non Formulary
 
Diumide-K Continus®

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Non Formulary
 
Enoxaparin  (Clexane®)

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Non Formulary
Black

Dalteparin is LMWH of choice in line with the OUHFT.

APCO September 2008.

 
Lasikal®

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Non Formulary
 
Lepirudin

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Non Formulary
 
Neo-NaClex-K®

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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 children's 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

Red: Medicines which should only be prescribed in secondary care by a specialist.  

Amber Continuation

Amber Continuation: Medicines which should be initiated or recommended by a specialist for continuation in primary care. The specialist must notify the GP that the prescribing responsibility has been transferred.   

Amber Shared Care Protocol

Amber Shared Care Protocol: Medicines which are appropriate to be initiated and stabilised by a specialist, once stabilised the medicine may be appropriate for responsibility to be transferred from secondary to primary care with the agreement of a GP and a formal ‘shared care’ agreement. The shared care protocol must be approved by the Area Prescribing Committee Oxfordshire (APCO).   

Green

Green: Medicines which are suitable for initiation and ongoing prescribing within primary care.   

Brown

Brown: Medicines which should only be prescribed in restricted circumstances.  

Black

Black: Medicines which are not recommended for use because of lack of evidence of clinical effectiveness, cost effectiveness or safety.  

OCCG Green

not used  

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