CLINICAL GUIDELINE FOR MANAGEMENTS OF PATIENTS TAKING ANTICOAGULANTS IN ENDOSCOPY 1. Aim/Purpose of this Guideline

Size: px
Start display at page:

Download "CLINICAL GUIDELINE FOR MANAGEMENTS OF PATIENTS TAKING ANTICOAGULANTS IN ENDOSCOPY 1. Aim/Purpose of this Guideline"

Transcription

1 CLINICAL GUIDELINE FOR MANAGEMENTS OF PATIENTS TAKING ANTICOAGULANTS IN ENDOSCOPY 1. Aim/Purpose of this Guideline 1.1. The purpose of this guideline is to assist decision making of whether anticoagulants (and antiplatelet agents) should be stopped and when prior to endoscopy. It is designed to be used both by those referring patients for endoscopy and those undertaking endoscopic procedures. ABBREVIATIONS USED IN THIS GUIDELINE EMR: endoscopic mucosal resection ERCP: endoscopic retrograde cholangio-pancreatography EUS: endoscopic ultrasound FNA: fine needle aspirate GI: gastro-intestinal NOAC: novel oral anticoagulants PEG: percutaneous endoscopic gastrostomy 2. The Guidance 2.1. One of the major risk factors of all endoscopic procedures is bleeding. This risk is dependent upon the nature of the planned procedure and whether the patient is taking is taking any anti-platelet or anticoagulant medication. The risk of bleeding can be reduced by stopping such medication in a timely fashion but this can increase the risk to patient of thrombo-embolic disease. The degree of this risk is determined by the underlying disease for which the anticoagulant is prescribed. It is important that all these factors are considered when a patient is being referred for endoscopy and an appropriate decision made to ensure patient safety. This should be stated on the request form (CHA 1926, 1927, 1928 as appropriate, or by electronic ordering when available) to enable the endoscopy booking team to ensure patients are managed safely Determining the risk of an endoscopic procedure. Procedures which breach the mucosa are generally high risk procedures, excepting standard diagnostic biopsies which do not increase the risk of clinically significant bleeding. Sometimes it is uncertain prior to a procedure whether it will be a low or high risk procedure eg colonoscopy, when it is unknown whether a polyp requiring removal will be found. In these circumstances it is the decision of the referrer to weigh up the risk of stopping the anticoagulant versus the risk of a repeat procedure if a polyp is found and the anticoagulant has been continued. LOW RISK FOR BLEEDING Diagnostic upper GI +/- biopsies Diagnostic lower GI +/- biopsies HIGH RISK FOR BLEEDING Therapeutic upper GI endoscopy Dilation; variceal banding, PEG insertion, EMR Therapeutic lower GI endoscopy Polypectomy, EMR Page 1 of 9

2 Biliary or pancreatic stenting (ERCP) Diagnostic EUS ERCP with sphincterotomy EUS with FNA Determining the risk of stopping anti-platelets/ anticoagulants. The risk of stopping antiplatelets/ anticoagulants will be determined by the underlying disease process for which they were prescribed. This will be highly individualized for each patient but the following general principles apply: LOW RISK FOR STOPPING: THROMBO-EMBOLIC DISEASE SOLITARY AF SINGLE EPISODE OF DVT/PE >3 MONTHS AGO CORONARY ARTERY STENTS >12 MONTHS AGO NON-DRUG ELUTING CORONARY ARTERY STENTS HIGH RISK FOR STOPPING: THROMBO-EMBOLIC DISEASE AF AND PREVIOUS STROKE MULTIPLE DVT/PEs DRUG ELUTING CORONARY ARTERY STENTS <12 MONTHS AGO If the referrer is uncertain the risk of stopping the anti-platelet/ anticoagulant medication, this should be discussed with the Consultant who initiated the treatment or a senior member of their team Determining the risk of the individual antiplatelet/ anticoagulant drug Aspirin: antiplatelet agent, effects persist for 7-10 days post last ingestion. No evidence on increased risk of bleeding in endoscopy, even high risk procedures CONTINUE IN ALL CASES Clopidogrel: antiplatelet agent, effects for 7-10 days post last ingestion. Evidence for increased risk of bleeding in endoscopy with high risk procedures STOP FOR HIGH RISK PROCEDURES 7-10 DAYS BEFORE. If high risk patient (prosthetic valves etc) can give sc heparin until 24 hours preprocedure Warfarin (phenindione): vitamin K antagonist Oral anticoagulant: effect measurable as prothrombin time (PT: INR) Aim for INR <1.4 for therapeutic (high risk) procedures CONTINUE FOR LOW RISK PROCEDURES but check INR within week of procedure (aim for THERAPEUTIC INR): NB safe to biopsy STOP 5 DAYS BEFORE AND MEASURE INR FOR HIGH RISK PROCEDURES. If high risk patient (prosthetic valves etc) can give sc heparin until 24 hours pre-procedure Novel oral anticoagulants: Rivaroxaban (Xarelto) and Apixaban (Eliquis): direct inhibitors of activated factor X and Dabigatran (Pradaxa): direct thrombin inhibitor MONITORING: Page 2 of 9

3 DABIGATRAN: APTT, TT, ecarin clotting time RIVAROXABAN: PT, modified anti-xa assay NO DIRECT ACTING REVERSAL AGENT RIVAROXABAN AND DABIGATRAN (AT 150mg BD) INCREASE RISK OF GI BLEEDING cf WARFARIN RENALLY EXCRETED IF NORMAL RENAL FUNCTION, STOPPING 1-2 DAYS BEFOREHAND MEANS CLOTTING WILL BE NORMAL (SHORT HALF-LIVES: 4-9 HOURS (R), HOURS (A),14-17 HOURS (D)) RISK OF BLEEDING = 5% FOR LOW RISK PROCEDURES, 20% HIGH RISK ALL NOVEL ORAL ANTICOAGULANTS TO BE STOPPED FOR ALL PROCEDURES, AS SHOWN BELOW. Stop 24 hours before low risk procedure, hours before high risk procedure and normal egfr (>50ml/min) Stop 48 hours before low risk, 4 days before high risk if egfr >30 and <50 ml/min Stop 72 hours before low risk and 5 days before high risk if egfr <30ml/min. Restart 6-8 hours post procedure for low risk and 48 hours post procedure for high risk (consider clexane as bridge if high risk thrombo-embolic disease) Do not restart if egfr <30ml/min (contra-indication to NOAC) See Woodhouse C et al. Frontline Gastroenterol 2013;4: for further information Dipyridamole: there are no studies of the risks of endoscopy for patients taking dipyridamole. The risk of spontaneous gastro-intestinal haemorrhage is less than with aspirin and BSG Guidelines in 2007 concluded that as aspirin can be safely continued during endoscopic procedures.. the same policy can be applied to dipyridamole Making an appropriate and safe decision regarding antiplatelet/ anticoagulant medication Low risk procedures: all patients should have aspirin, clopidogrel, dipyridamole and warfarin continued (INR to be checked within 7 days of procedure and procedure to be deferred if above therapeutic range). All patients should have novel oral anticoagulants (dabigatran, apixaban, rivaroxaban) stopped for the procedure and restarted as per table above High risk procedures: all patients should have aspirin and dipyridamole continued. Clopidogrel and warfarin should be stopped 7 days before the procedure (and INR checked <48 hours before procedure). All patients should have novel oral anticoagulants (dabigatran, apixaban, rivaroxaban) stopped for the procedure and restarted as per table above. If there is a high risk in stopping antiplatelet drugs/ anticoagulants consideration should be given to deferring the endoscopic procedure if the antiplatelet drugs/ anticoagulants will be stopped in the foreseeable future. Where they will not be stopped soon, and the endoscopy is necessary, then consideration should be given to covering the pre and post procedure Page 3 of 9

4 periods with heparin. If in doubt, management should be discussed with their cardiologist/ stroke specialist/ haematologist as appropriate Emergency endoscopy: On some occasions, especially when clinically significant gastrointestinal bleeding has occurred it will not be possible to stop antiplatelet/ anticoagulants in a timely fashion. Management of patients taking warfarin is available from the Document library Patient who have GI bleeding and are taking one of the NOAC should be discussed with the on call haematologist. Where possible endoscopy should be deferred for at least 24 hours since the last dose (see Table above). If this is not possible and all blood products have been given to reverse the effect of the agent, then endoscopy can proceed but the endoscopist should ensure that the patient is aware that the endoscopic procedure carries and increased risk of iatrogenic complications (bleeding) and document this. 3. Monitoring compliance and effectiveness Element to be monitored Lead Tool Frequency 1. All patients taking clopidogrel or oral anticoagulants will have a decision made regarding whether it should be discontinued or not documented. 2. All low risk procedure patients will have clopidogrel/ warfarin continued for their procedure 3. All high risk patients will have clopidogrel/ warfarin stopped for their procedure 4. All patients will have novel oral anticoagulants stopped for their procedure Drs Murray and Fortun 1. The endoscopy booking team will audit endoscopy referral to determine whether a decision is documented when the patient is taking clopidogrel/ anticoagulants. If electronic endoscopy booking is initiated as planned, this element will not require monitoring as it will not be possible to request an endoscopy without the decision being documented. 2. All endoscopy staff will Datix any breach of elements 2-4 as above and all Datixes are discussed at the gastroenterology monthly governance meetings. Ongoing monitoring Recorded in monthly governance meeting minutes Reporting arrangements Acting on recommendations Recorded in monthly governance meeting minutes (and shared governance meeting with surgery every 6 months) See above The lead or committee is expected to read and interrogate the report to identify deficiencies in the system and act upon them Endoscopy lead/ Medical and surgical gastroenterology governance leads Page 4 of 9

5 and Lead(s) Change in practice and lessons to be shared Required actions will be identified and completed in a specified timeframe. See above 4. Equality and Diversity 4.1. This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2. Page 5 of 9

6 Appendix 1. Governance Information Document Title Date Issued/Approved: 21 Oct 13 Date Valid From: 21 Oct 13 Date Valid To: 21 Oct 16 Clinical Guideline for Managements of Patients Taking Anticoagulants in Endoscopy Directorate / Department responsible (author/owner): Iain Murray, Consultant Gastroenterologist Contact details: Brief summary of contents Suggested Keywords: Target Audience Executive Director responsible for Policy: Guidelines to aid decision making and management of anticoagulants and antiplatelet drugs in patients undergoing endoscopy Endoscopy, Gastroscopy, Colonoscopy, ERCP, Anticoagulants, Clopidogrel, Rivaroxaban, Apixaban, Dabigatran RCHT PCH CFT KCCG Medical Director Date revised: 21 Oct 16 This document replaces (exact title of previous version): Approval route (names of committees)/consultation: Divisional Manager confirming approval processes Clinical Guideline for Managements of Patients Taking Anticoagulants in Endoscopy Endoscopy users group, medical and surgical GI governance meetings, Dr Creagh (haematology), Dr Slade (cardiology), Dr Adie (stroke medicine) Andrew Virr Name and Post Title of additional signatories Signature of Executive Director giving approval Publication Location (refer to Policy on Policies Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Not Required {Original Copy Signed} Internet & Intranet Intranet Only Clinical / Gastroenterology None Page 6 of 9

7 Related Documents: Training Need Identified? html No Version Control Table Date Version No 4 Oct 13 V1.0 Initial Issue 21 Oct 13 V1.1 Summary of Changes Change to the timing of stopping warfarin in keeping with national guidelines. Changes Made by (Name and Job Title) Iain Murray, Consultant Gastroenterologist Iain Murray, Consultant Gastroenterologist All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager. Page 7 of 9

8 Appendix 2.Initial Equality Impact Assessment Screening Form Name of service, strategy, policy or project (hereafter referred to as policy) to be assessed: Clinical Guideline for Managements of Patients Taking Anticoagulants in Endoscopy Directorate and service area: Medicine/ Is this a new or existing Procedure? New gastroenterology Name of individual completing Telephone: assessment: Iain Murray 1. Policy Aim* Safe management of antiplatelet and anticoagulant therapy in patients having endoscopic procedures 2. Policy Objectives* To ensure that all patients undergoing endoscopic procedures have correct management of their antiplatelet/ anticoagulant therapy 3. Policy intended Outcomes* 5. How will you measure the outcome? All patients being referred for endoscopy have an evidence based plan for their anticoagulant therapy which his appropriate Auditing numbers of referrals without such a management plan and also those where the plan is deemed inappropriate 5. Who is intended to benefit from the Policy? All patients taking anticoagulant/ antiplatelet therapy who are undergoing endoscopy 7. The Impact Please complete the following table. Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Rationale for Assessment / Existing Evidence Age Sex (male, female, transgender / gender reassignment) Race / Ethnic communities /groups Disability - learning disability, physical disability, sensory impairment and mental health problems Religion / other beliefs Marriage and civil partnership Pregnancy and maternity Page 8 of 9

9 Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian You will need to continue to a full Equality Impact Assessment if the following have been highlighted: You have ticked Yes in any column above and No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or Major service redesign or development 8. Please indicate if a full equality analysis is recommended. Yes No 9. If you are not recommending a Full Impact assessment please explain why. Signature of policy developer / lead manager / director Date of completion and submission Names and signatures of members carrying out the Screening Assessment 1. Iain Murray 2. Keep one copy and send a copy to the Human Rights, Equality and Inclusion Lead, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Knowledge Spa, Truro, Cornwall, TR1 3HD A summary of the results will be published on the Trust s web site. Signed Date Page 9 of 9

This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital

This guideline is for the management of Adult patients with Diabetes Mellitus using insulin pump therapy during admission to hospital CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS USING INSULIN PUMP THERAPY (Continuous Subcutaneous Insulin Infusion (CSII)), DURING ADMISSION TO HOSPITAL 1. Aim/Purpose of this

More information

CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME

CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME CLINICAL GUIDELINE FOR THE MANAGEMENT OF HYPERGLYCAEMIA IN ADULTS WITH ACUTE CORONARY SYNDROME 1. Aim/Purpose of this Guideline This guideline is for the management of Adult patients with Diabetes Mellitus

More information

Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0

Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0 Occupational Therapy Service in the Emergency Department at Royal Cornwall Hospital V1.0 January 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Ownership

More information

CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED HEALTHCARE PRACTITIONERS EMPLOYED WITHIN MINOR INJURY UNITS IN CORNWALL

CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED HEALTHCARE PRACTITIONERS EMPLOYED WITHIN MINOR INJURY UNITS IN CORNWALL CLINICAL IMAGING REFERRAL PROTOCOL FOR REGISTERED HEALTHCARE PRACTITIONERS EMPLOYED WITHIN MINOR 1. Aim/Purpose of this Guideline This Protocol applies to Registered Healthcare Practitioners in the Minor

More information

CLINICAL GUIDELINE FOR ADVANCED NURSE PRACTITIONER HEPATOLOGY (GASTROENTEROLOGY) 1. Aim/Purpose of this Guideline:

CLINICAL GUIDELINE FOR ADVANCED NURSE PRACTITIONER HEPATOLOGY (GASTROENTEROLOGY) 1. Aim/Purpose of this Guideline: CLINICAL GUIDELINE FOR ADVANCED NURSE PRACTITIONER HEPATOLOGY (GASTROENTEROLOGY) 1. Aim/Purpose of this Guideline: 1.1. This protocol applies to Advanced Nurse Practitioners (Hepatology) employed by RCHT

More information

SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline

SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline SEPSIS IN INFANTS AND CHILDREN- CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. This guideline is for the management of sepsis in Infants and children. For full guidance please see the Surviving

More information

Accounts Receivable - Guidance to staff responsible for the collection of income following the supply of goods or services V4.0

Accounts Receivable - Guidance to staff responsible for the collection of income following the supply of goods or services V4.0 Accounts Receivable - Guidance to staff responsible for the collection of income following the supply of goods or services V4.0 June 2015 Table of Contents Accounts Receivable - Guidance to staff responsible

More information

CLINICAL GUIDELINE HOW TO PERFORM A VENESECTION, DETAILING VEIN SELECTION AND PATIENT CARE 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE HOW TO PERFORM A VENESECTION, DETAILING VEIN SELECTION AND PATIENT CARE 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE HOW TO PERFORM A VENESECTION, DETAILING VEIN SELECTION AND PATIENT CARE 1. Aim/Purpose of this Guideline 1.1. Venesection is a clinical procedure commonly performed in the Haematology

More information

CLINICAL GUIDELINE FOR THE USE OF INTRAVENOUS SLIDING SCALE REGIMEN FOR ADULTS 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR THE USE OF INTRAVENOUS SLIDING SCALE REGIMEN FOR ADULTS 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR THE USE OF INTRAVENOUS SLIDING SCALE REGIMEN FOR ADULTS 1. Aim/Purpose of this Guideline This guideline is for the management of for the management of Adult patients with Diabetes

More information

CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start

CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start CLINICAL GUIDELINE FOR CHANGING A CATHETER EXIT SITE DRESSING (I.E. MIDLINE/ CVC/ PICC/ HICKMAN) Summary. Start 1. Assemble all your equipment before you start. 2. Explain and discuss the procedure with

More information

Summary: Record all actions and contact on the Community Midwives Caseload Card for the woman

Summary: Record all actions and contact on the Community Midwives Caseload Card for the woman DID NOT ATTEND (DNA) OR BOOKED LATE FOR ANTENATAL CARE - CLINICAL GUIDELINE Summary: Record all actions and contact on the Community Midwives Caseload Card for the woman Woman has DNA an appointment Document

More information

Guidance on Leases and other Agreements V4.0

Guidance on Leases and other Agreements V4.0 Guidance on Leases and other Agreements V4.0 August 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 3 5. Ownership and Responsibilities...

More information

2.1 When a breastfeeding woman is admitted to hospital, the support she needs depends on the nature of her illness and the treatment needed

2.1 When a breastfeeding woman is admitted to hospital, the support she needs depends on the nature of her illness and the treatment needed CARE OF BREASTFEEDING WOMEN ADMITTED TO HOSPITAL, CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 Breastfeeding is known to be one of the most powerful health protective influences and as such,

More information

Procedure for Non-Medical Staff who wish to Request MRI, Ultrasound and Imaging Examinations under IR(ME)R

Procedure for Non-Medical Staff who wish to Request MRI, Ultrasound and Imaging Examinations under IR(ME)R Procedure for Non-Medical Staff who wish to Request MRI, Ultrasound and Imaging V3.0 December 2013 Page 1 of 11 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope...

More information

2.1. Applicable areas: Royal Cornwall Hospitals Trust; Neonatal Unit and Delivery Suite

2.1. Applicable areas: Royal Cornwall Hospitals Trust; Neonatal Unit and Delivery Suite ADVANCED NEONATAL NURSE PRACTITIONERS (ANNPs) BLOOD COMPONENT AND BLOOD PRODUCT REQUESTING PROTOCOL NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 The purpose of this protocol is to guide

More information

Guidance on Stocktaking V4.0

Guidance on Stocktaking V4.0 V4.0 November 2015 Summary. Stocktaking is carried out to for accounting purposes, identification of over/under stocking, identify obsolete or damaged stock. A physical check of stocks must be undertaken

More information

23/06/2014. Implications for the Gastroenterologist. No financial interests I am not a hematologist

23/06/2014. Implications for the Gastroenterologist. No financial interests I am not a hematologist Implications for the Gastroenterologist Dr. Daniel Sadowski Royal Alexandra Hospital Edmonton, Ab. No financial interests I am not a hematologist 65 y.o. male referred for iron deficiency anemia (FIT positive)

More information

PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline

PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline PENINSULA NETWORK GUIDANCE ON NOVEL ANTICOAGULANTS FOR STROKE AND TIA MANAGEMENT 1. Aim/Purpose of this Guideline The aim of this document to guide clinicians on use of novel anticoagulants for stroke

More information

Diagnostic Testing Procedures for Ophthalmic Science

Diagnostic Testing Procedures for Ophthalmic Science V3.0 09/06/15 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3. Scope... 3 4. Definitions / Glossary... 3 5. Ownership and Responsibilities... 3 5.2. Role of the Managers... 3 5.3.

More information

CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS DURING SURGERY / ELECTIVE PROCEDURES

CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS DURING SURGERY / ELECTIVE PROCEDURES - 1 - CLINICAL GUIDELINE FOR THE MANAGEMENT OF ADULT PATIENTS DIABETES MELLITUS DURING SURGERY / ELECTIVE PROCEDURES For procedures requiring bowel preparation please refer to: Guidelines for the Care

More information

PREGNANCY OF UNKNOWN LOCATION (PUL) - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline

PREGNANCY OF UNKNOWN LOCATION (PUL) - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline PREGNANCY OF UNKNOWN LOCATION (PUL) - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline All clinical staff working in the Division of women, children & sexual health to provide evidence based guidance

More information

STROKE AND TIA MULTIDISCIPLINARY CARE PATHWAY 6 th Edition Cornwall Stroke Service (Royal Cornwall Hospital Trust Facing)

STROKE AND TIA MULTIDISCIPLINARY CARE PATHWAY 6 th Edition Cornwall Stroke Service (Royal Cornwall Hospital Trust Facing) STROKE AND TIA MULTIDISCIPLINARY CARE PATHWAY 6 th Edition Cornwall Stroke Service (Royal Cornwall Hospital Trust Facing) 1. Aim/Purpose of this Guideline The aim of this document to inform clinicians

More information

Access Control Policy V1.0

Access Control Policy V1.0 V1.0 January 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 4 5. Ownership and Responsibilities... 4 5.1. Role of the Chief

More information

MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE

MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE MANAGEMENT OF DIRECT ANTIGLOBULIN TEST (DAT) POSITIVE INFANTS NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1. To provide monitoring and treatment guidance for medical and nursing staff

More information

Title of Guideline. Thrombosis Pharmacist)

Title of Guideline. Thrombosis Pharmacist) Title of Guideline Contact Name and Job Title (author) Guideline for patients receiving Rivaroxaban (Xarelto ) requiring Emergency Surgery or treatment for Haemorrhage Julian Holmes (Haemostasis and Thrombosis

More information

The Use of Electronic signatures for Prescribing Chemotherapy and data entries on the Aria MedOncology system V3.0

The Use of Electronic signatures for Prescribing Chemotherapy and data entries on the Aria MedOncology system V3.0 The Use of Electronic signatures for Prescribing Chemotherapy and data entries on the Aria MedOncology system V3.0 January 2013 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3.

More information

Clinical Guideline For The Use of Rectus Sheath Catheters For The Management of Pain Following Laparotomy. 1. Aim/Purpose of this Guideline

Clinical Guideline For The Use of Rectus Sheath Catheters For The Management of Pain Following Laparotomy. 1. Aim/Purpose of this Guideline Clinical Guideline For The Use of Rectus Sheath Catheters For The Management of Pain Following Laparotomy. 1. Aim/Purpose of this Guideline 1.1. Nursing guidelines for the use of rectus sheath catheters

More information

OXYGEN THERAPY AND SATURATION MONITORING OF THE NEONATE - CLINICAL GUIDELINE

OXYGEN THERAPY AND SATURATION MONITORING OF THE NEONATE - CLINICAL GUIDELINE OYGEN THERAPY AND SATURATION MONITORING OF THE NEONATE - CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline 1.1 To provide guidance on the assessment and management of infants requiring oxygen therapy

More information

1.1. Safe and effective use of intermittent pneumatic compression to prevent DVT and PE in stroke patients

1.1. Safe and effective use of intermittent pneumatic compression to prevent DVT and PE in stroke patients CLINICAL GUIDELINE FOR PREVENTION OF DEEP VENOUS THROMBOSIS (DVT) AND PULMONARY EMBOLI (PE) IN STROKE PATIENTS USING INTERMITTENT PNEUMATIC LEG COMPRESSION 1. Aim/Purpose of this Guideline 1.1. Safe and

More information

Infection Prevention & Control Roles and Responsibilities Policy V4.0

Infection Prevention & Control Roles and Responsibilities Policy V4.0 Infection Prevention & Control V4.0 01.05.2015 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 3 5. Ownership and Responsibilities...

More information

CLINICAL GUIDELINE FOR THE EMERGENCY DEFILL OF AN ADJUSTABLE GASTRIC BAND

CLINICAL GUIDELINE FOR THE EMERGENCY DEFILL OF AN ADJUSTABLE GASTRIC BAND CLINICAL GUIDELINE FOR THE EMERGENCY DEFILL OF AN ADJUSTABLE GASTRIC BAND 1. Aim/Purpose of this Guideline The aim of this guideline to enable the effective care of patients needing emergency defill of

More information

CHADS score of 5 or 6 Recent (within 3mo) stroke or TIA Rheumatic valvular heart disease CHADs score of 3 or 4

CHADS score of 5 or 6 Recent (within 3mo) stroke or TIA Rheumatic valvular heart disease CHADs score of 3 or 4 LAMC Department of Pharmacy Services: ANTICOAGULATION: Surgical Intervention Table 1: Classification of Surgical interventions according to bleeding risk t required to discontinue anticoagulation Dental

More information

EDUCATIONAL AIMS: ANTICOAGULATION

EDUCATIONAL AIMS: ANTICOAGULATION EDUCATIONAL AIMS: ANTICOAGULATION 1.The old and the new 2. Elective patient peri-procedural management 3.The acute bleed BACKGROUND Anticoagulants and antiplatelet agents: some of the commonest causes

More information

CLINICAL GUIDELINE FOR SECONDARY PREVENTION AFTER STROKE OR TIA (PRIMARY AND SECONDARY CARE CORNWALL) MANAGEMENT 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR SECONDARY PREVENTION AFTER STROKE OR TIA (PRIMARY AND SECONDARY CARE CORNWALL) MANAGEMENT 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR SECONDARY PREVENTION AFTER STROKE OR TIA (PRIMARY AND SECONDARY CARE CORNWALL) MANAGEMENT 1. Aim/Purpose of this Guideline The aim of this document to inform clinicians on management

More information

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016 Version 1.4 EQIA Yes 01/06/2012

More information

Appendix C Factors to consider when choosing between anticoagulant options and FAQs

Appendix C Factors to consider when choosing between anticoagulant options and FAQs Appendix C Factors to consider when choosing between anticoagulant options and FAQs Choice of anticoagulant for non-valvular* atrial fibrillation: Clinical decision aid Patients should already be screened

More information

CLINICAL GUIDELINE FOR

CLINICAL GUIDELINE FOR CLINICAL GUIDELINE FOR the investigation and management of inpatients with discitis (vertebral osteomyelitis) 1. Aim/Purpose of this Guideline 1.1.This guideline applies to clinical staff managing patients

More information

Starting Salaries Policy. Document Title. Date Issued/Approved: July 2012. Date Valid From: 14 August 2012. Date Valid To: 13 March 2017

Starting Salaries Policy. Document Title. Date Issued/Approved: July 2012. Date Valid From: 14 August 2012. Date Valid To: 13 March 2017 POLICY UNDER REVIEW Please note that this policy is under review. It does, however, remain current Trust policy subject to any recent legislative changes, national policy instruction (NHS or Department

More information

Dr Gordon Royle Haematologist, Middlemore Hospital

Dr Gordon Royle Haematologist, Middlemore Hospital The New Oral Anticoagulants (NOACs) Dr Gordon Royle Haematologist, Middlemore Hospital Disclaimers Boehringer-Ingelheim Bayer Sanofi Douglas Pharmaceuticals Preventing disasters: lessons learned A cautionary

More information

Guidance to Staff responsible for the Ordering, Authorising and Payment of goods and services received

Guidance to Staff responsible for the Ordering, Authorising and Payment of goods and services received Guidance to Staff responsible for the Ordering, Authorising and Payment of goods and services received V3.0 June 2015 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3.

More information

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care

Antiplatelet and Antithrombotic Therapy. Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Antiplatelet and Antithrombotic Therapy Dr Curry Grant Stroke Prevention Clinic Quinte Health Care Disclosure of Potential for Conflict of Interest Dr. F.C. Grant Atrial Fibrillation FINANCIAL DISCLOSURE:

More information

Dr Gordon Royle Haematologist, Middlemore Hospital

Dr Gordon Royle Haematologist, Middlemore Hospital The New Oral Anticoagulants (NOACs) Dr Gordon Royle Haematologist, Middlemore Hospital Disclaimers Boehringer-Ingelheim Bayer Sanofi Douglas Pharmaceuticals Preventing disasters: lessons learned A cautionary

More information

New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis

New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis New Oral Anticoagulants Increase Risk for Gastrointestinal Bleeding - A Systematic Review and Meta-Analysis Holster IL, Valkhoff VE, Kuipers EJ, Tjwa ET Departments of Gastroenterology and Hepatology,

More information

CLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR MANAGEMENT OF NEUTROPENIC SEPSIS IN CANCER PATIENTS 1. Aim/Purpose of this Guideline 1.1. Systemic cancer treatments and immunological therapies can suppress the ability of the bone

More information

East Kent Prescribing Group

East Kent Prescribing Group East Kent Prescribing Group Rivaroxaban (Xarelto ) Safety Information Approved by the East Kent Prescribing Group. Approved by: East Kent Prescribing Group (Representing Ashford CCG, Canterbury and Coastal

More information

Dorset Cardiac Centre

Dorset Cardiac Centre P a g e 1 Dorset Cardiac Centre Patients with Atrial Fibrillation/Flutter undergoing DC Cardioversion or Ablation procedures- Guidelines for Novel Oral Anti-coagulants (NOACS) licensed for this use February

More information

NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST

NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST NOACS AND AF PEARLS AND PITFALLS DR LAURA YOUNG HAEMATOLOGIST NGAIRE IS 70 YEARS OLD AND IN AF. SHE HAS NO MURMURS, NORMAL BLOOD PRESSURE, EGFR OF 65ML/MIN AND NO SIGNIFICANT PAST MEDICAL HISTORY. REGARDING

More information

A Policy for the Trial and Evaluation of Medical Devices

A Policy for the Trial and Evaluation of Medical Devices 29/05/2014 V2.1 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3. Scope... 3 4. Definitions... 3 5. Ownership and Responsibilities... 4 5.1. Role of the Trust Board and Medical Director...

More information

Clinical Guideline N/A. November 2013

Clinical Guideline N/A. November 2013 State if the document is a Trust Policy/Procedure or a Clinical Guideline Clinical Guideline Document Title: Document Number 352 Version Number 1 Name and date and version number of previous document (if

More information

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations

Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Novel oral anticoagulant (NOAC) for stroke prevention in atrial fibrillation Special situations Dardo E. Ferrara MD Cardiac Electrophysiology North Cascade Cardiology PeaceHealth Medical Group Which anticoagulant

More information

Grievance and Disputes Policy and Procedure. Document Title. Date Issued/Approved: 10 August 2010. Date Valid From: 21 December 2015

Grievance and Disputes Policy and Procedure. Document Title. Date Issued/Approved: 10 August 2010. Date Valid From: 21 December 2015 POLICY UNDER REVIEW Please note that this policy is under review. It does, however, remain current Trust policy subject to any recent legislative changes, national policy instruction (NHS or Department

More information

PHARMACISTS AMENDMENTS TO PRESCRIPTIONS

PHARMACISTS AMENDMENTS TO PRESCRIPTIONS PHARMACISTS AMENDMENTS TO PRESCRIPTIONS May 2016 Version 2.3 Table of Contents 1. Introduction... 3 2. Purpose of this Policy... 3 3. Scope... 3 4. Definitions/Glossary... 3 5. Ownership and Responsibilities...

More information

NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS

NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS NHS FORTH VALLEY RIVAROXABAN AS TREATMENT FOR DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM IN ADULTS Date of First Issue 01/12/ 2012 Approved 15/11/2012 Current Issue Date 29/10/2014 Review Date 29/10/2016

More information

Financial Disclosures. Learning Objectives 05/06/2015. None

Financial Disclosures. Learning Objectives 05/06/2015. None ANTITHROMBOTIC MANAGEMENT PRE AND POST ENDOSCOPY Dustin Loomes, MD, FRCPC, Advanced training in Inflammatory Bowel Disease University of Alberta Hospital, Edmonton, AB St. Paul s Hospital, Vancouver, BC

More information

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation

NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation NHS FORTH VALLEY Rivaroxaban for Stroke Prevention in Atrial Fibrillation Date of First Issue 06/06/2012 Approved 06/06/2012 Current Issue Date 06/06/2012 Review Date 06/06/2014 Version 1.1 EQIA Yes /

More information

9/28/15. Dabigatran. Rivaroxaban. Apixaban. Edoxaban. From the AC Forum Centers of Excellence website: Dabigatran, Rivaroxaban, & Apixaban

9/28/15. Dabigatran. Rivaroxaban. Apixaban. Edoxaban. From the AC Forum Centers of Excellence website: Dabigatran, Rivaroxaban, & Apixaban Identify the FDA approved direct oral anticoagulants (DOACs) Linda Kelly, PharmD, PhC, CACP Presbyterian Healthcare Services Distinguish the differences in the dosing of DOACs for various indications Describe

More information

Cardiology Update 2014

Cardiology Update 2014 Cardiology Update 2014 Update on the Novel Oral Anticoagulants (NOACS) Raymond Kawasaki, MD AMG Cardiology December 6, 2014 Disclosures I have no disclosures relevant to this presentation Contents I. The

More information

STROKE PREVENTION IN ATRIAL FIBRILLATION

STROKE PREVENTION IN ATRIAL FIBRILLATION STROKE PREVENTION IN ATRIAL FIBRILLATION OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention of ischemic stroke and arterial thromboembolism in patients

More information

Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008:

Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Key Points to consider when prescribing NOACs Introduction Three new/novel oral anticoagulants (NOAC) have been licensed in Ireland since 2008: Dabigatran Etexilate (Pradaxa ) 75mg, 110mg, 150mg. Rivaroxaban

More information

What You Should NOAC About the New Anticoagulants. Dr Calum Young Cardiologist

What You Should NOAC About the New Anticoagulants. Dr Calum Young Cardiologist What You Should NOAC About the New Anticoagulants Dr Calum Young Cardiologist Overview The Burden of AF What s Wrong With Warfarin? The Era of NOACs NOACs in New Zealand Clinical Trials with NOACs Potential

More information

Management of Antithrombotic Therapy in the Peri-endoscopic Period: An Update

Management of Antithrombotic Therapy in the Peri-endoscopic Period: An Update Management of Antithrombotic Therapy in the Peri-endoscopic Period: An Update Nimeesh Shah, MD March 6, 2015 Santa Clara Valley Medical Center Stanford University School of Medicine None Financial Disclosures

More information

Traditional anticoagulants

Traditional anticoagulants TEGH Family Practice Clinic Day April 4, 03 Use of Anticoagulants in 03: What s New (and What Isn t) Bill Geerts, MD, FRCPC Director, Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University

More information

Bridging anticoagulation: the peri-procedural management of patients on oral anticoagulants (excluding neurosurgery)

Bridging anticoagulation: the peri-procedural management of patients on oral anticoagulants (excluding neurosurgery) Barnsley Hospital NHS Foundation Trust Bridging anticoagulation: the peri-procedural management of patients on oral anticoagulants (excluding neurosurgery) Reproduced and Adapted from the Sheffield Bridging

More information

HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below

HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below Name: generic (trade) Rivaroxaban (Xarelto ) HERTFORDSHIRE MEDICINES MANAGEMENT COMMITTEE (HMMC) RIVAROXABAN RECOMMENDED see specific recommendations for licensed indications below What it is Indications

More information

New Oral Anticoagulants. How safe are they outside the trials?

New Oral Anticoagulants. How safe are they outside the trials? New Oral Anticoagulants How safe are they outside the trials? Objectives The need for anticoagulant therapy Indications for anticoagulation Traditional anticoagulant therapies Properties of new oral anticoagulants

More information

GRASP-AF Coming to a PCT near you.

GRASP-AF Coming to a PCT near you. GRASP-AF Coming to a PCT near you. ADAS Anticoagulation dosing advisory service Blackpool Teaching Hospitals Trust Sean O'Brien; Anticoagulation Specialist BMS Grasp-AF and the implications on our Anticoagulation

More information

Dabigatran (Pradaxa) Guidelines

Dabigatran (Pradaxa) Guidelines Dabigatran (Pradaxa) Guidelines Dabigatran is a new anticoagulant for reducing the risk of stroke in patients with atrial fibrillation. Dabigatran is a direct thrombin inhibitor, similar to warfarin, without

More information

Novel Oral Anticoagulants (NOACs) Prescriber Update 2013

Novel Oral Anticoagulants (NOACs) Prescriber Update 2013 Novel Oral Anticoagulants (NOACs) Prescriber Update 2013 Indications/Contraindications Indications Orthopedic VTE Prophylaxis VTE Treatment Stroke Prevention for non-valvular AF Contraindications 150 mg

More information

Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia

Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Use of Antithrombotic Agents In The Presence Of Neuraxial Anesthesia Insertion, removal or presence of a catheter in selected sites can place a patient who is antithrombotic agent at risk for a local bleeding

More information

NWMIC Medicines FAQ. New oral anticoagulants (NOACs) and management of dental patients - Dabigatran, rivaroxaban and apixaban.

NWMIC Medicines FAQ. New oral anticoagulants (NOACs) and management of dental patients - Dabigatran, rivaroxaban and apixaban. NWMIC Medicines FAQ New oral anticoagulants (NOACs) and management of dental patients - Date prepared: May 2013, updated November 2013 Summary In primary care; Consider liaising with the local hospital

More information

Stopping Anti-platelet Agents: Will You Cause a Stroke?

Stopping Anti-platelet Agents: Will You Cause a Stroke? Stopping Anti-platelet Agents: Will You Cause a Stroke? Glenn M. Eisen MD,MPH The Oregon Clinic-West Hills GI Clinical Professor of Medicine, OHSU Thanks for staying. 1 Don t cause a stroke Objective(s)

More information

The author has no disclosures

The author has no disclosures Mary Bradbury, PharmD, BCPS Clinical Pharmacy Specialist, Cardiac Surgery September 18, 2012 Mary.bradbury@inova.org This presentation will discuss unlabeled and investigational use of products The author

More information

NOAC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions

NOAC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions AC Prescribing in Patients with Non-Valvular Atrial Fibrillation: Frequently Asked Questions FAQ document jointly prepared by NHSGGC Haematology Service & Medicines Infmation On behalf of the Heart MCN

More information

Use of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps

Use of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps Use of Novel Oral Anticoagulants (NOACs) and the new DAWN modules at Scripps Cheryl Ea, Pharm D. Anticoagulation Services Scripps Clinic and Scripps Green Hospital La Jolla, California Pharmacist Management

More information

CLINICAL GUIDELINE FOR THE MANAGEMENT OF HIGH BLOOD GLUCOSE LEVELS AND SICK DAYS ON AN INSULIN PUMP. 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR THE MANAGEMENT OF HIGH BLOOD GLUCOSE LEVELS AND SICK DAYS ON AN INSULIN PUMP. 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR THE MANAGEMENT OF HIGH BLOOD GLUCOSE LEVELS AND SICK DAYS ON AN INSULIN PUMP. 1. Aim/Purpose of this Guideline 1.1. The purpose of this guideline is to give clear information and

More information

3/25/14. To Clot or Not What s New In Anticoagulation? Clotting Cascade. Anticoagulant drug targets. Anita Ralstin, MS CNS CNP. Heparin.

3/25/14. To Clot or Not What s New In Anticoagulation? Clotting Cascade. Anticoagulant drug targets. Anita Ralstin, MS CNS CNP. Heparin. To Clot or Not What s New In Anticoagulation? Anita Ralstin, MS CNS CNP 1 Clotting Cascade 2 Anticoagulant drug targets Heparin XI VIII IX V X VII LMWH II Warfarin Fibrin clot 1 Who Needs Anticoagulation

More information

CLINICAL GUIDELINE FOR THE MANAGEMENT OF OPIATE DEPENDENT PATIENTS AT RCHT 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR THE MANAGEMENT OF OPIATE DEPENDENT PATIENTS AT RCHT 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR THE MANAGEMENT OF OPIATE DEPENDENT PATIENTS AT RCHT 1. Aim/Purpose of this Guideline 1.1. These guidelines are aimed at Medical Staff at RCHT treating patients admitted that are

More information

Tenders and Quotations Financial Procedures V3.0

Tenders and Quotations Financial Procedures V3.0 V3.0 31 December 2014 Table of Contents 1. Introduction... 3 2. Purpose of this Policy/Procedure... 3 3. Scope... 3 4. Definitions / Glossary... 3 5. Ownership and Responsibilities... 3 5.2 Role of the

More information

GREEN ZONE No action needed. You are doing great

GREEN ZONE No action needed. You are doing great Blood Thinner Safety Plan: Which zone are you in? Check your zone often to stay healthy and safe The name of my blood thinner is: (CIRCLE the medications you take): Coumadin (warfarin) Pradaxa (dabigatran)

More information

Bridging Anticoagulation: The Peri-Procedural Management of Patients on Oral Anticoagulants

Bridging Anticoagulation: The Peri-Procedural Management of Patients on Oral Anticoagulants Bridging Anticoagulation: The Peri-Procedural Management of Patients on Oral Anticoagulants Dr Stuti Kaul- Consultant Haematologist Dr Youssef Sorour- Consultant Haematologist Lee Wilson- Consultant Pharmacist

More information

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND:

STROKE PREVENTION IN ATRIAL FIBRILLATION. TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: ABBREVIATIONS: BACKGROUND: STROKE PREVENTION IN ATRIAL FIBRILLATION TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To guide clinicians in the selection of antithrombotic therapy for the secondary prevention

More information

Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation.

Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation. South West Essex Rivaroxaban Shared Care Guideline (SCG) Rivaroxaban shared care guidelines for the prevention of stroke and embolism in adult patients with nonvalvular atrial fibrillation. Introduction

More information

Introduction. Background to this event. Raising awareness 09/11/2015

Introduction. Background to this event. Raising awareness 09/11/2015 Introduction Primary Care Medicines Governance HSCB Background to this event New class of medicines Availability of training Increasing volume of prescriptions Reports of medication incidents Raising awareness

More information

All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation

All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation All Wales Risk/Benefit Assessment Tool for Oral Anticoagulant Treatment in People with Atrial Fibrillation October 2013 This report has been prepared by a multiprofessional collaborative group, with support

More information

Anticoagulant therapy

Anticoagulant therapy Anticoagulation: The risks Anticoagulant therapy 1990 2002: 600 incidents reported 120 resulted in death of patient 92 deaths related to warfarin usage 28 reports related to heparin usage Incidents in

More information

NHS FIFE WIDE POLICY - HAEMATOLOGY MANAGEMENT OF ANTICOAGULATION THERAPY DURING MAJOR AND MINOR ELECTIVE SURGERY

NHS FIFE WIDE POLICY - HAEMATOLOGY MANAGEMENT OF ANTICOAGULATION THERAPY DURING MAJOR AND MINOR ELECTIVE SURGERY MANAGEMENT OF ANTICOAGULATION THERAPY DURING MAJOR AND MINOR ELECTIVE SURGERY The scope of this guideline is to simplify the management of patients on oral anticoagulation undergoing major and minor surgery.

More information

Optimizing Anticoagulation Selection for Your Patient. C. Andrew Brian MD, FACC NCVH 2015

Optimizing Anticoagulation Selection for Your Patient. C. Andrew Brian MD, FACC NCVH 2015 Optimizing Anticoagulation Selection for Your Patient C. Andrew Brian MD, FACC NCVH 2015 Who Needs to Be Anticoagulated and What is the Patient s Risk? 1. Atrial Fibrillation ( nonvalvular ) 2. What regimen

More information

high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor

high thrombotic risk, we recommend continuing aspirin and liaising with a cardiologist about the risk/benefit of discontinuation of P2Y12 receptor Guideline 1 Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy

More information

Critical Bleeding Reversal Protocol

Critical Bleeding Reversal Protocol Critical Bleeding Reversal Protocol Coagulopathy, either drug related or multifactorial, is a major contributing factor to bleeding related mortality in a variety of clinical settings. Standard therapy

More information

Management of the new antiplatelets and anticoagulants

Management of the new antiplatelets and anticoagulants Management of the new antiplatelets and anticoagulants Session No.: 1 Name: C. Boustiere, T Ponchon Guidelines : Anti-thrombotic agents and digestive endoscopy 2006 : French guideline (SFED) 2007 : Japanese

More information

Comparison between New Oral Anticoagulants and Warfarin

Comparison between New Oral Anticoagulants and Warfarin Comparison between New Oral Anticoagulants and Warfarin Warfarin was the mainstay of oral anticoagulant therapy until the recent discovery of more precise targets for therapy. In recent years, several

More information

The Role of the Newer Anticoagulants

The Role of the Newer Anticoagulants The Role of the Newer Anticoagulants WARFARIN = Coumadin DAGIBATRAN = Pradaxa RIVAROXABAN = Xarelto APIXABAN = Eliquis INDICATION DABIGATRAN (Pradaxa) RIVAROXABAN (Xarelto) APIXABAN (Eliquis) Stroke prevention

More information

COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS. TARGET AUDIENCE: All Canadian health care professionals.

COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS. TARGET AUDIENCE: All Canadian health care professionals. COMPARISON OF NEW ORAL ANTICOAGULANTS AND FREQUENTLY- ASKED QUESTIONS FROM PATIENTS AND PHYSICIANS TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVES: To provide a comparison of the new

More information

Committee Approval Date: September 12, 2014 Next Review Date: September 2015

Committee Approval Date: September 12, 2014 Next Review Date: September 2015 Medication Policy Manual Policy No: dru361 Topic: Pradaxa, dabigatran Date of Origin: September 12, 2014 Committee Approval Date: September 12, 2014 Next Review Date: September 2015 Effective Date: November

More information

The Anticoagulated Patient A Hematologist s Perspective

The Anticoagulated Patient A Hematologist s Perspective The Anticoagulated Patient A Hematologist s Perspective Deborah M. Siegal MD MSc FRCPC Clinical Scholar Division of Hematology and Thromboembolism Thrombosis Canada Research Fellow McMaster University

More information

CLINICAL GUIDELINE FOR THE MANAGEMENT OF ANAPHYLAXIS IN INFANTS AND CHILDREN UNDER SIXTEEN YEARS OF AGE. 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR THE MANAGEMENT OF ANAPHYLAXIS IN INFANTS AND CHILDREN UNDER SIXTEEN YEARS OF AGE. 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR THE MANAGEMENT OF ANAPHYLAIS IN INFANTS AND CHILDREN UNDER SITEEN YEARS OF AGE. 1. Aim/Purpose of this Guideline 1.1. The purpose of this guideline is to provide a clear care pathway

More information

Warfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab

Warfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab Warfarin and Novel Anti-Coagulants: Management Before and After the Cath Lab Drew Baldwin, MD Virginia Mason Seattle, Washington NCVH May 28, 2015 2:30 pm I have no disclosures. Stroke risk reduction in

More information

INSERTION OF UMBILICAL LINES ARTERIAL (UAC) and VENOUS (UVC) - NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline

INSERTION OF UMBILICAL LINES ARTERIAL (UAC) and VENOUS (UVC) - NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline INSERTION OF UMBILICAL LINES ARTERIAL (UAC) and VENOUS (UVC) - NEONATAL CLINICAL GUIDELINE 1. Aim/Purpose of this Guideline This guideline applies to all staff undertaking the procedure of umbilical line

More information