Pathway for the management of DVT in primary Care
|
|
- Piers Hawkins
- 7 years ago
- Views:
Transcription
1 Pathway for the management of DVT in primary Care Final Version: Approved by NHS DGS CCG: June 2015 This document aims to support practices in DGS CCG in the Management & Treatment of patients with suspected and confirmed DVT. Date of Review: June 2017 Page 1 of 11
2 Version Control Version Date Comments Contributor Version 1 January 2012 New guidance issued Jabeen Egan Version 2 February 2015 Updated for dxs format Rachna Selvan Jabeen Egan Version 3 June 2015 Addition of Apixaban according to NICE [TA341] Rachna Selvan The following contributed to the development of these guidelines: Dr Janet Hall GP Prescribing Lead NHS DGS CCG Dr D Woodhead GP Governing body NHS DGS CCG Jabeen Egan Lead Pharmacist NHS DGS CCG Rachna Selvan Prescribing Advisor NHS DGS CCG Date of Review: June 2017 Page 2 of 11
3 Patient Pathway for the management of DVT in primary Care Suspected DVT Clinical assessment according to the Wells Score (if both legs are affected score on the worse leg) Wells Score 1 Wells Score 2 No DVT, STOP TREATMENT Consider alternative diagnosis Negative *Start immediate treatment dose of either LMWH OR NOAC (Rivaroxaban or Apixaban) Ultrasound *Start immediate treatment dose of either LMWH OR NOAC (Rivaroxaban or Apixaban) Ultrasound Negative Reassess Clinical Features of the Patient? Positive Positive Confirmed DVT Follow treatment pathway Confirmed DVT Follow treatment pathway *Check BNF/SPC for any contraindications to treatment before initiating. See Treatment pathway *Consult product literature for details of managing patients with renal impairment *For patients with egfr <30ml/min/1.73m 2 for whom Rivaroxaban is unsuitable Offer unfractionated heparin. If DVT likely use clinical judgment and Repeat ultrasound after 1 week Positive Use clinical judgement to STOP TREATMENT if DVT not likely. Consider alternative diagnosis Negative Confirmed DVT Follow treatment pathway Date of Review: June 2017 Page 3 of 11 Ultrasound negative NO DVT Consider alternative diagnosis.patient to be reassessed as seen fit by the GP
4 Clinical feature Points Active cancer (treatment ongoing, within 6 months, or palliative) 1 Paralysis, paresis or recent plaster immobilisation of the lower extremities 1 Recently bedridden for 3 days or more or major surgery within 12 weeks 1 requiring general or regional anaesthesia Localised tenderness along the distribution of the deep 1 venous system Entire leg swollen 1 Calf swelling at least 3 cm larger than asymptomatic side 1 Pitting oedema confined to the symptomatic leg 1 Collateral superficial veins (non-varicose) 1 Previously documented DVT 1 An alternative diagnosis is at least as likely as DVT -2 Table 1 Two-level DVT Wells score Clinical probability simplified score DVT likely DVT unlikely 2 points or more 1 point or less Date of Review: June 2017 Page 4 of 11
5 TREATMENT PATHWAY Patient Pathway confirmed DVT Consider Treatment with either NOAC OR LMWH plus Warfarin Consider NOAC Consider Warfarin -Patients who do not have severe renal impairment <15ml/min (consider product literature for moderate impairment) -Patients on long-term Warfarin who have poor control -Patients with other medical conditions that require regular introductions of medications which interfere with warfarin, e.g. COPD with antibiotics, and cause the need for very frequent INR monitoring/dose changes -Patients who are currently managed on LMWH because of difficulty in INR monitoring Consideration- Warfarin may be more appropriate for: -Patients who are contraindicated to Rivaroxaban (Risk of major bleeding e.g. recent gastro-intestinal ulcer, oesophageal varices, recent brain, spine or ophthalmic surgery, recent intracranial haemorrhage, malignant neoplasms, vascular aneurysm) -Patients who are breastfeeding -Patients whom you wish to monitor their INR to assess compliance to treatment -Patients with poor mobility who find it difficult to attend outpatient clinics and/or require home visits not be able to self-monitor INR -If Patients would benefit from not incurring drug/food interactions (as with warfarin) Treat with NOAC -Counsel Patient fully -Continue with initial treatment: Rivaroxaban: 15mg twice daily with food for 21 days, then for continued treatment and prophylaxis of recurrent deep vein thrombosis 20mg once daily with food. Apixaban: 10mg twice daily for 7 days followed by 5mg twice daily. -The duration of therapy should be individualised after careful assessment of the treatment benefit against risk for bleeding. Short duration of therapy (at least 3 months) should be based on transient risk factors (e.g. recent surgery, trauma, and immobilisation) and longer durations should be based on permanent risk factors or idiopathic DVT or PE. Treat with Warfarin -Counsel patient fully re: anticoagulation, including information leaflet and anticoagulant card -Prescribe warfarin appropriately to achieve target INR 2.5 for 6 weeks for isolated calf-vein deep vein thrombosis & at least 3 months for unprovoked proximal deep vein thrombosis. -Monitor INR daily or on alternate days of treatment, then at longer intervals (depending on response) then upto every 12 weeks -It is essential that the INR be determined daily or alternate days in early treatment, then at longer intervals (depending on response) then up to every 12 weeks. Date of Review: June 2017 Page 5 of 11
6 PRESCRIBING INFORMATION Dose Duration Monitoring Comments Daltaparin (Fragmin ) Actual Weight (kg) Dose (units) Syringe Colour ,500 GREEN ,000 RED ,500 ORANGE ,000 PURPLE Until adequate Oral Anticoagulatio n established Monitoring not required for once daily treatment Lower doses if should be considered in patients with significant liver/renal failure CrCl <30ml/min >83 18,000 WHITE Enoxaparin (Clexane ) Dosage chart for 1.5mg/kg S/C Actual Weight (kg) Dose mg & Vol. to administer (ml) Syringe Colour mg(0.55ml) Orange mg (0.6ml) 60mg/0.6ml mg(0.65ml) Brown mg(0.7ml) mg(0.75ml) 80mg/0.8ml Until adequate Oral Anticoagulatio n established Monitoring not required for once daily treatment Enoxaparin dose reduced to 1mg/kg ONCE DAILY in patients with renal impairment CrCl<30ml/min mg(0.8ml) mg(0.85ml) BLACK mg(0.9ml) 100mg/1ml mg(0.95ml) mg(1ml) mg(0.7ml) Mauve mg(0.74mg) 120mg/0.8ml mg(0.76ml) mg(0.8ml) mg(0.84) BLUE mg(0.86ml) 150mg/ml mg(0.9) mg(0.94ml) mg(0.96ml) mg(1.0ml) Warfarin Prescribe warfarin appropriately to achieve target INR 2.5 for 6 weeks for isolated calf-vein deep vein thrombosis & at least 3 months for unprovoked proximal deep vein thrombosis. 6 weeks for isolated calfvein deep thrombosis Monitor INR daily or on alternate days of treatment, Counsel Patient on anticoagulatio n with warfarin Date of Review: June 2017 Page 6 of 11
7 At least 3 months for unprovoked proximal deep vein thrombosis then at longer intervals (depending on response) then up to every 12 weeks fully including drug/drug and food/drug interactions. Issue patients with anticoagulatio n card and information leaflets Rivaroxaban Initial treatment 15mg twice daily with food for 21 days. Continued treatment and prophylaxis of recurrent deep vein thrombosis 20mg once daily with food Individualised after careful assessment of the treatment benefit against risk for bleeding. None Counsel Patient on anticoagulatio n fully CAUTION IN : Creatinine clearance 15-29ml/min Apixaban Initial treatment 10mg twice daily for 7 days followed by 5mg twice daily. Individualised after careful assessment of the treatment benefit against risk for bleeding. None Counsel Patient on anticoagulatio n fully CAUTION IN : Creatinine clearance 15-29ml/min Date of Review: June 2017 Page 7 of 11
8 SUPPORTING INFORMATION Introduction and Background Venous thrombosis is a condition in which a blood clot (thrombus) forms in a vein. Blood flow through the affected vein can be limited by the clot, causing swelling and pain in the affected limb or area. Venous thrombosis most commonly occurs in the deep veins in the legs, thighs, or pelvis. This is known as a deep vein thrombosis. An embolism is created if a part or all of the blood clot in the deep vein breaks off from the site where it is created and travels through the venous system. If the clot lodges in the lung a very serious condition, pulmonary embolism (PE), arises, which can be life threatening. Venous thrombosis can form in any part of the venous system. However, deep vein thrombosis (DVT) and PE are the most common manifestations of venous thrombosis. DVT and PE are known as venous thromboembolism (VTE). Low Molecular Weight Heparins LMWHs are used in the prevention of venous thromboembolism (prophylaxis) in patients at moderate to high risk, and are given in a low dose. LMWHs are also used in the treatment of venous thromboembolism in patients who develop a DVT or PE and are given in a higher dose. As LMWHs work very quickly, they are used concurrently with warfarin in the first few days of treatment for patients with a DVT or PE, and are continued until the INR is in the target range. Once the INR is in the target range (showing that the Warfarin is working sufficiently) then the LMWH is stopped. However, not all patients can take warfarin and therefore LMWHs are sometimes used for longer periods of time instead of warfarin. When used for prevention of DVT or PE, LMWHs are given for as long as the patient is deemed to be at high risk, and then they are stopped. Novel Oral Anti-coagulants Rivaroxaban Works as a direct inhibitor of activated factor X (Factor Xa). It is given orally for the treatment of DVT and its main advantage is its immediate action negating the need for low molecular weight Heparin (LMWH. Furthermore it does not require routine anticoagulant monitoring (INR tests are unreliable in patients taking Rivaroxaban). Rivaroxaban Contraindications Rivaroxaban is not recommended for use in children below 18 Creatinine clearance <15ml/min Pregnancy Breastfeeding Concomitant treatment with any other anticoagulants, unless switching therapy see guidance below Date of Review: June 2017 Page 8 of 11
9 Hypersensitivity to the active substance or to any of the excipients listed as the end of this document Avoid in liver disease with coagulopathy Active bleeding; significant risk of major bleeding (e.g. recent gastrointestinal ulcer, oesophageal varices, recent brain, spine or ophthalmic surgery, recent intracranial haemorrhage, malignant neoplasms, vascular aneurysm) Missed doses Day 1-21: If a dose is missed during Day 1-21, the patient should take Rivaroxaban immediately to ensure intake of 30mg per day. In this case two 15mg tablets may be taken at once. The patient should continue with the regular 15mg twice daily intake as recommended on the following day. Day 22 and onwards: The patient should take Rivaroxaban immediately, and continue on the following day with the once daily intake as recommended. The dose should not be doubled within the same day to make up for a missed dose. Renal Impairment Normal renal function Mild renal impairment Renal Function (creatinine clearance 50-80ml/min) Moderate renal impairment (creatinine clearance 30-49ml/min) Severe renal impairment (creatinine clearance 15-29ml/min) Established renal failure (creatinine clearance <15) Recommendations 15mg twice daily for 3 weeks (21days) following diagnosis then 20mg once daily thereafter No dose adjustment required 15mg twice daily for the first 3 weeks. Thereafter 20mg once daily. A reduction of the dose from 20mg to 15mg once daily should be considered if the patients assessed risk for bleeding outweighs the risk for recurrent DVT. The recommendation for 15mg use is based on PK modelling and has not been studied in a clinical setting. Rivaroxaban plasma concentrations significantly increased. Use with caution as moderate renal impairment dosing instructions. Avoid use No dose adjustments are required for body weight or the elderly. Switching Anticoagulant Therapy Converting from Vitamin K Antagonists (VKA) to Rivaroxaban VKA treatment should be stopped and Rivaroxaban therapy should be initiated once the INR <2.5 INR values will be falsely elevated after the intake of Rivaroxaban The INR is not valid to measure the anticoagulant activity of Rivaroxaban and therefore should not be used Converting from Rivaroxaban to Vitamin K Antagonists (VKA) Continuous adequate anticoagulation should be ensured during any transition to an alternate anticoagulant. Rivaroxaban can contribute to an elevated INR VKA should be given concurrently until the INR is > 2.0 Date of Review: June 2017 Page 9 of 11
10 For the first two days of the conversion period, standard initial dosing of VKA should be used followed by VKA dosing, as guided by INR testing While patients are on both Rivaroxaban and VKA the INR should not be tested earlier than 24hours after the previous dose but prior to the next dose of Rivaroxaban Once Rivaroxaban is discontinued INR testing may be done reliably at least 24hrs after the last dose Converting from parental anticoagulants to Rivaroxaban Discontinue the parenteral anticoagulant and start Rivaroxaban 0 to 2 hours before the time that the next scheduled administration of the parenteral medicinal product (e.g. low molecular weight heparins) would be due or at the time of discontinuation of a continuously administered parenteral medicinal product. Converting from Rivaroxaban to parental anticoagulants Give the first dose of parenteral anticoagulant at the time the next Rivaroxaban dose would be taken Rivaroxaban Drug interactions Analgesics (iv diclofenac, ketorolac) Anti-arrhythmics (dronedarone) Antibacterials (rifampicin) Anticoagulants Antidepressants Antiepileptic s Antifungals Antivirals Cobicistat Increased risk of haemorrhage Avoid concomitant use Plasma concentration of Rivaroxaban reduced by rifampicin. Monitor signs of thrombosis. Avoid use Risk of bleeding avoid concomitant use except when switching Plasma concentrations of Rivaroxaban possibly reduced by St John s wort Plasma concentrations of Rivaroxaban possibly reduced by carbamazepine, phenobarbital and phenytoin Avoid concomitant use with Iitraconazole, posaconazole and voriconazole Avoid concomitant use with atazanavir, darunavir, fosamprenavir, indinavir, saquinavir, tipranavir and lopinavir. Plasma concentration of Rivaroxaban increased by ritnovir Anticoagulant effect of Rivaroxaban possibly enhanced by cobicistat Date of Review: June 2017 Page 10 of 11
11 References Wells PS et al. (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis British National Formulary (BNF) Ed. 68 (September 2014) BMJ Publishing Group and RPS Publishing. London Summary of product characteristics. Rivaroxaban (Xarelto ) access via: Nice TA 261 July2012: Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and Pulmonary embolism. Date of Review: June 2017 Page 11 of 11
Title Use of rivaroxaban in suspected DVT in the Emergency Department Standard Operating Procedure. Author s job title. Pharmacist.
Document Control Title Use of rivaroxaban in suspected DVT in the Emergency Department Author Pharmacist Directorate Clinical Support Services Version Date Issued Status 0.1 Oct Draft 2015 1.0 Dec Final
More informationPrescriber Guide. 20mg. 15mg. Simply Protecting More Patients. Simply Protecting More Patients
Prescriber Guide 20mg Simply Protecting More Patients 15mg Simply Protecting More Patients 1 Dear Doctor, This prescriber guide was produced by Bayer Israel in cooperation with the Ministry of Health as
More informationThe Prescribing pathway consists of a number of parts:
NHS EAST LANCASHIRE CCG & NHS BLACKBURN WITH DARWEN CCG DVT Primary Care Prescribing Pathway www.elmmb.nhs.uk Introduction www.elmmb.nhs.uk Version 1.2/January 2013 Introduction Blackburn with Darwen and
More informationNHS 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 informationPatient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust.
Patient Group Direction Hospital: Bristol Royal Infirmary Department: UHBristol Thrombosis Service University Hospitals Bristol NHS Foundation Trust. This Patient Group Direction (PGD) has been written
More informationRivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Implementation of NICE TA 261 Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism Contents 1. Executive summary 2. Introduction
More informationNew 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 informationHERTFORDSHIRE 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 informationEnoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants
Enoxaparin for long term anticoagulation in patients unsuitable for oral anticoagulants Traffic light classification- Amber 2 Information sheet for Primary Care Prescribers Relevant Licensed Indications
More informationTo provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.
DEEP VEIN THROMBOSIS: TREATMENT TARGET AUDIENCE: All Canadian health care professionals. OBJECTIVE: To provide an evidenced-based approach to treatment of patients presenting with deep vein thrombosis.
More informationVolume 7; Number 19 November 2013
Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire
More informationRivaroxaban for the treatment of Deep Vein Thrombosis in patients unsuitable for vitamin K antagonists
Rivaroxaban for the treatment of Deep Vein Thrombosis in patients unsuitable for vitamin K antagonists Traffic light classification- Amber 2 specialist initiation Information sheet for Primary Care Prescribers
More informationEast 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 informationConfirmed Deep Vein Thrombosis (DVT)
Confirmed Deep Vein Thrombosis (DVT) Information for patients What is deep vein thrombosis? Blood clotting provides us with essential protection against severe loss of blood from an injury to a vein or
More informationImplementation of NICE TAs 261 and 287
Corby Clinical Commissioning Group Kettering General Hospital NHS Trust Nene Clinical Commissioning Group Northampton General Hospital NHS Trust Northamptonshire Healthcare Foundation Trust Implementation
More informationDVT/PE Management with Rivaroxaban (Xarelto)
DVT/PE Management with Rivaroxaban (Xarelto) Rivaroxaban is FDA approved for the acute treatment of DVT and PE and reduction in risk of recurrence of DVT and PE. FDA approved indications: Non valvular
More informationACUTE DVT MANAGEMENT Richard J. DeMasi, MD April 26, 2014
ACUTE DVT MANAGEMENT Richard J. DeMasi, MD April 26, 2014 Thromboembolism epidemiology 5 million DVT s 900,000 PE s 290,000 fatalities Heit J. Blood. 2005;106:910. 10 VTE events Since this talk began DVT
More informationVolume 7; Number 15 August 2013
Greater East Midlands Commissioning Support Unit in association with Lincolnshire Clinical Commissioning Groups, Lincolnshire Community Health Services, United Lincolnshire Hospitals Trust and Lincolnshire
More informationPRESCRIBING GUIDELINES FOR THE MANAGEMENT OF PATIENTS ANTICOAGULANT THERAPY
PRESCRIBING GUIDELINES FOR THE MANAGEMENT OF PATIENTS ON ANTICOAGULANT THERAPY Prepared by: NPSA Anticoagulation Steering Group Approved by: Wirral Drug & Therapeutics Committee 14 th May 2008 Review:
More informationDrug name: RIVAROXABAN (Xarelto ) For the treatment of acute venous thromboembolism in adult patients.
Drug name: RIVAROXABAN (Xarelto ) For the treatment of acute venous thromboembolism in adult patients. DOCUMENT TO BE SCANNED INTO ELECTRONIC RECORDS AS AND FILED IN NOTES Patient Name : Date of Birth:
More informationXARELTO (RIVAROXABAN) EDUCATIONAL PACK FOR 15MG AND 20MG DOSING
XARELTO (RIVAROXABAN) EDUCATIONAL PACK FOR 15MG AND 20MG DOSING NOW UPDATED A N D I N C L U D E S A NEW INDICATION Prevention of stroke and systemic embolism in eligible adult patients with non-valvular
More informationRivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF
Leeds Rivaroxaban: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your
More informationAnticoagulation at the end of life. Rhona Maclean Rhona.maclean@sth.nhs.uk
Anticoagulation at the end of life Rhona Maclean Rhona.maclean@sth.nhs.uk Content Anticoagulant Therapies Indications for anticoagulation Venous thromboembolism (VTE) Atrial Fibrillation Mechnical Heart
More informationThe 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 informationDorset 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 informationXARELTO (RIVAROXABAN) PRESCRIBER GUIDE
XARELTO (RIVAROXABAN) PRESCRIBER GUIDE Prescribing information found on pages 16-17 This guide is to be used to support the appropriate use of Xarelto in the following indications: Prevention of stroke
More informationNational Guidance and New Protocols
National Guidance and New Protocols Dr Jane Strong Consultant Haematologist DVT clinical lead Acute VTE chair DAWN AC Twentieth User Group Meeting 8 th October 2012 Autumn dawn Restless geese take flight
More informationOutpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013
Outpatient Treatment of Deep Vein Thrombosis with Low Molecular Weight Heparin (LMWH) Clinical Practice Guideline August 2013 General Principles: There is compelling data in the medical literature to support
More informationNational Guidance and New Protocols
National Guidance and New Protocols Dr Jane Strong Consultant Haematologist DVT clinical lead Acute VTE chair DAWN AC Twentieth User Group Meeting 8 th October 2012 DVT patient pathway Assessment Diagnosis
More informationBirmingham, Sandwell and Solihull Cardiac and Stroke Network. Rivaroxaban or warfarin for treatment of Atrial Fibrillation: Position statement
Birmingham, Sandwell and Solihull Cardiac and Stroke Network Rivaroxaban or warfarin for treatment of Atrial Fibrillation: Position statement Introduction This guidance informs prescribers and commissioners
More informationXARELTO (RIVAROXABAN) PRESCRIBER GUIDE
XARELTO (RIVAROXABAN) PRESCRIBER GUIDE Prescribing information found on pages 22-23 This guide is to be used to support the appropriate use of Xarelto in the following indications: Prevention of stroke
More informationMEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization
MEDICAL ASSISTANCE HBOOK PRI AUTHIZATION OF PHARMACEUTICAL SERVICES I. Requirements for Prior Authorization of Anticoagulants A. Prescriptions That Require Prior Authorization Prescriptions for Anticoagulants
More informationRivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)
Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep
More informationVenous Thromboembolic Treatment Guidelines
Venous Thromboembolic Treatment Guidelines About the NYU Venous Thromboembolic Center (VTEC) The center s mission is to deliver advanced screening, detection, care, and management services for patients
More informationNovel 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 informationTraditional 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 informationrivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (755/12) Bayer PLC
rivaroxaban 15 and 20mg film-coated tablets (Xarelto ) SMC No. (755/12) Bayer PLC 13 January 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS
More informationXarelto (rivaroxaban) Prescriber Guide November 2012
Xarelto (rivaroxaban) Prescriber Guide November 2012 Simple Protection for More Patients 2 Xarelto Prescriber Guide Patient Alert Card 4 Dosing Recommendations 4 Dosing in patients with atrial fibrillation
More informationDorset Medicines Advisory Group
Shared Care Guideline for prescribing rivaroxaban in the prevention of adverse outcomes after acute management of acute coronary syndrome in adults INDICATION In accordance with NICE TA335 rivaroxaban
More informationUncontrolled when printed. Version 1.1. Acute Sector. Lead Author/Co-ordinator: Mr Simon Barker Consultant Orthopaedic Surgeon Julie Fraser
Acute Sector NHS Grampian Staff Local Treatment Protocol For Venous Thromoboembolic Prophylaxis Using Rivaroxaban 10mg Tablets In Adult Patients Undergoing Elective Hip Or Knee Replacement Surgery. Lead
More informationNew Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis. Mark Crowther
New Anticoagulants for the Treatment of Thromboembolism With a little subplot on superficial thrombophlebitis Mark Crowther 1 Disclosures Advisory Boards in last 24 months Pfizer, Alexion, Bayer, CSL Behring,
More informationXarelto (rivaroxaban) Prescriber Guide
Xarelto (rivaroxaban) Prescriber Guide Patient Alert Card A patient alert card must be provided to each patient who is prescribed Xarelto 15 or 20 mg, and the implications of anticoagulant treatment should
More information3/3/2015. Patrick Cobb, MD, FACP March 2015
Patrick Cobb, MD, FACP March 2015 I, Patrick Cobb, MD, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict
More information2. Background This indication of rivaroxaban had not previously been considered by the PBAC.
PUBLIC SUMMARY DOCUMENT Product: Rivaroxaban, tablets, 15mg and 20mg, Xarelto Sponsor: Bayer Australia Ltd Date of PBAC Consideration: March 2013 1. Purpose of Application The application requested the
More informationCDEC FINAL RECOMMENDATION
CDEC FINAL RECOMMENDATION RIVAROXABAN (Xarelto Bayer Inc.) New Indication: Pulmonary Embolism Note: The Canadian Drug Expert Committee (CDEC) previously reviewed rivaroxaban for the treatment of deep vein
More informationThe legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 10 March 2010
The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 10 March 2010 ARIXTRA 1.5 mg/0.3 ml, solution for injection in pre-filled syringe Box of 2 (CIP: 363 500-6) Box of
More informationAppendix 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 informationHow To Take Xarelto
A patient's guide Your clinic's contact details are: Name: Contact number: Contents 2 Why have I been prescribed Xarelto? 2 What is Xarelto? 3 How do I take Xarelto? 3 What should I do if I miss a dose
More informationNHS 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 informationAnticoagulation Dosing at UCDMC Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h
Indication Agent Standard Dose Comments and Dose Adjustments VTE Prophylaxis All Services UFH 5,000 units SC q 8 h See EMR adult VTE prophylaxis CI order set Enoxaparin See service specific dosing Assess
More informationThrombosis and Hemostasis
Thrombosis and Hemostasis Wendy Lim, MD, MSc, FRCPC Associate Professor, Department of Medicine McMaster University, Hamilton, ON Overview To review the important developments in venous thromboembolism
More informationXarelto (rivaroxaban) Prescriber Guide
Xarelto (rivaroxaban) Prescriber Guide Simple Protection For More Patients 2 Xarelto Prescriber Guide Patient Alert Card 4 Dosing Recommendations 4 Dosing in patients with atrial fibrillation 4 Patients
More informationDevang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical
Devang M. Desai, MD, FACC, FSCAI Chief of Interventional Cardiology Director of Cardiac Catheterization Lab St. Mary s Hospital and Regional Medical Center A.Fib affects 2.2 million Americans. The lifetime
More informationExecutive Summary. Motive for the request for advice
Executive Summary Motive for the request for advice Currently nearly 400,000 people in the Netherlands are being treated with anticoagulants of a type Vitamin K antagonists (VKAs). Although VKAs are very
More informationA PATIENT S GUIDE TO DEEP VEIN THROMBOSIS TREATMENT
A PATIENT S GUIDE TO DEEP VEIN THROMBOSIS TREATMENT This medicine is subject to additional monitoring. This will allow quick identification of new safety information. If you get any side effects, talk
More informationNEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM
NEWER ANTICOAGULANTS: FOCUS ON STROKE PREVENTION IN ATRIAL FIBRILLATION AND DEEP VEIN THROMBOSIS/PULMONARY EMBOLISM Carol Lee, Pharm.D., Jessica C. Song, M.A., Pharm.D. INTRODUCTION For many years, warfarin
More information2.5mg SC daily. INR target 2-3 30 mg SC q 12 hr or 40mg daily. 10 mg PO q day (CrCl 30 ml/min). Avoid if < 30 ml/min. 2.
Anticoagulation dosing at UCDMC (SC=subcutaneously; CI=continuous infusion) Indication Agent Dose Comments Prophylaxis Any or No bleeding risk factors see adult heparin (VTE prophylaxis) IV infusion order
More informationShared Care Guideline between Trusts and CCGs. Drug name: RIVAROXABAN (Xarelto ) For the treatment of acute venous thromboembolism in adult patients.
Shared Care Guideline between Trusts and CCGs Drug name: RIVAROXABAN (Xarelto ) For the treatment of acute venous thromboembolism in adult patients. DOCUMENT TO BE SCANNED INTO ELECTRONIC RECORDS AS AND
More informationBreadth of indications matters One drug for multiple indications
Breadth of indications matters One drug for multiple indications Sylvia Haas, MD, PhD Formerly of the Technical University of Munich Munich, Germany Disclosures: Sylvia Haas 1 Novel oral anticoagulants:
More informationUHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient
Guidelines for Anticoagulation Initiation and Management Y2014 UHS CLINICAL CARE COLLABORATION: Outpatient & Inpatient Topic Page Number MEDICATION FLOW AND PATIENT FLOW... 2 AND 3 PARENTERAL ANTICOAGULANTS...
More informationRivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary Issued: July 2012 guidance.nice.org.uk/ta NHS Evidence has accredited the process used
More informationAnticoagulant 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 informationNew Oral Anticoagulants
New Oral Anticoagulants Tracy Minichiello, MD Associate Professor of Medicine Chief, San FranciscoVA Anticoagulation and Thrombosis Service Ansell, J. Hematology Copyright 2010 American Society of Hematology.
More informationMEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. A. Prescriptions That Require Prior Authorization
MEDICAL ASSISTANCE HBOOK I. Requirements for Prior Authorization of Anticoagulants A. Prescriptions That Require Prior Authorization Prescriptions for Anticoagulants which meet any of the following conditions
More informationDabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF
Leeds Dabigatran: Amber Drug Guidance for the prevention of stroke and systemic embolism in patients with non-valvular AF Amber Drug Level 3 (amber drug with monitoring requirements) We have started your
More informationCommon Drug Review Pharmacoeconomic Review Report
Common Drug Review Pharmacoeconomic Review Report August 2015 Drug rivaroxaban (Xarelto) Indication Listing request Manufacturer Treatment of venous thromboembolic events (deep vein thrombosis [DVT], pulmonary
More informationTSOAC Initiation Checklist
Task Establish appropriate dose based on anticoagulant selected, indication and patient factors such as renal function. Evaluate for medication interactions that may necessitate TSOAC dose adjustment.
More informationThree 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 informationTA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation
Service Notification in response to DHSSPS endorsed NICE Technology Appraisals TA 256: Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation 1 Name of Commissioning
More informationDiagnosis and Treatment of VTE in the ER
UHN ER Conference Nov 3, 2015 Diagnosis and Treatment of VTE in the ER Bill Geerts Thromboembolism Program, Sunnybrook HSC Professor of Medicine, University of Toronto National Lead, VTE Prevention, Canadian
More informationFULL REVIEW. PBS listing. Rivaroxaban (Xarelto) NPS RADAR AUGUST 2013 KEY POINTS
1 FULL REVIEW for treatment of deep vein thrombosis and pulmonary embolism, and for prevention of venous thromboembolism recurrence (riv-ah-rocks-ah-ban) An alternative to parenteral anticoagulation with
More informationOxford Anticoagulation & Thrombosis Service Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE)
Oxford University Hospitals NHS Trust Oxford Anticoagulation & Thrombosis Service Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) Information for people with a blood clot (thrombus) What is this
More informationNHS 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 informationPreventing Blood Clots in Adult Patients. Information For Patients
Preventing Blood Clots in Adult Patients Information For Patients 1 This leaflet will give you information on how to reduce the risk of developing blood clots during and after your stay in hospital. If
More informationUse 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 informationClinical Study Synopsis
Clinical Study Synopsis This Clinical Study Synopsis is provided for patients and healthcare professionals to increase the transparency of Bayer's clinical research. This document is not intended to replace
More informationFDA Approved Oral Anticoagulants
FDA Approved Oral Anticoagulants Generic (Trade Name) Warfarin (Coumadin, Jantoven ) 1 FDA approved indication Prophylaxis and treatment of venous thromboembolism (VTE) Prophylaxis and treatment of thromboembolic
More informationXarelto (rivaroxaban) Prescriber Guide
Xarelto (rivaroxaban) Prescriber Guide May 2013 Simple Protection for More Patients 2 Xarelto Prescriber Guide Patient Alert Card 4 Dosing Recommendations 4 Dosing in patients with atrial fibrillation
More informationComparison 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 informationInpatient Anticoagulation Safety. To provide safe and effective anticoagulation therapy through a collaborative approach.
Inpatient Anticoagulation Safety Purpose: Policy: To provide safe and effective anticoagulation therapy through a collaborative approach. Upon the written order of a physician, Heparin, Low Molecular Weight
More informationUpdates to the Alberta Human Services Drug Benefit Supplement
Updates to the Alberta Human Services Drug Benefit Supplement Effective January 1, 2016 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone
More informationRivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Final appraisal determination Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism This guidance was developed using
More informationRivaroxaban (Xarelto) in the management of stroke and DVT
Rivaroxaban (Xarelto) in the management of stroke and DVT Steve Chaplin MSc, MRPharmS, Victoria Haunton BM, DGM, MRCP, Thompson Robinson BMedSci, MD, FRCP and Catherine Bagot MD, FRCPath KEY POINTS is
More informationRivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism
Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary Issued: July 2012 guidance.nice.org.uk/ta NICE has accredited the process used by the
More informationIndication: Indication: Protaxos is indicated in adults.
Maklumat tambahan indikasi untuk upload pada laman web Year 2013 Products Approved For Additional Indication (DCA 262 28 Mac 2013) NO PRODUCT (ACTIVE INGREDIENT) 1. 1.1 EVISTA TABLET 60MG [ Raloxifene
More informationHaematology for GP s Part 2. Anticoagulation in DVT and PE VTE. Introduction. DVT Principles of diagnosis. VTE in Bradford
Haematology for GP s Part 2 Anticoagulation in DVT and PE Introduction NICE guidelines DVT and PE diagnosis and treatment Warfarin New anticoagulants Cases VTE VTE is an important cause of morbidity and
More informationLiving with a Non-Vitamin K Antagonist Oral Anticoagulant (NOAC)
Living with a Non-Vitamin K Antagonist Oral Anticoagulant (NOAC) dabigatran (Pradaxa ) rivaroxaban (Xarelto ) apixaban (Eliquis ) Information for patients Produced and made available by the Western Australian
More informationGuidance for prescribing of Dabigatran (Pradaxa ) Rivaroxaban (Xarelto ) and Apixaban (Eliquis ) in Patients with Non-Valvular AF
Guidance for prescribing of Dabigatran (Pradaxa ) Rivaroxaban (Xarelto ) and Apixaban (Eliquis ) in Patients with Non-Valvular AF Lesley Davey Staffordshire and Lancashire CSU November 2013 (Review November
More informationA PATIENT S GUIDE TO PULMONARY EMBOLISM TREATMENT
A PATIENT S GUIDE TO PULMONARY EMBOLISM TREATMENT This medicine is subject to additional monitoring. This will allow quick identification of new safety information. If you get any side effects, talk to
More informationGruppo di lavoro: Malattie Tromboemboliche
Gruppo di lavoro: Malattie Tromboemboliche 2381 Soluble Recombinant Thrombomodulin Ameliorates Hematological Malignancy-Induced Disseminated Intravascular Coagulation More Promptly Than Conventional Anticoagulant
More informationPractical Management of Patients receiving Rivaroxaban 울산의대 서울아산병원 심장내과 최기준
Practical Management of Patients receiving Rivaroxaban 울산의대 서울아산병원 심장내과 최기준 Contents Converting to/from rivaroxaban Measuring levels of rivaroxaban Patients potentially at higher risk of bleeding Renal
More informationLung Pathway Group Nintedanib (Vargatef) in advanced Non-Small Cell Lung Cancer (NSCLC)
Lung Pathway Group Nintedanib (Vargatef) in advanced Non-Small Cell Lung Cancer (NSCLC) Indication: In combination with docetaxel in locally advanced, metastatic or locally recurrent NSCLC of adenocarcinoma
More informationVenous thromboembolism: reducing the risk. Quick reference guide. Issue date: January 2010
Issue date: January 2010 Venous thromboembolism: reducing the risk Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital This guideline
More informationLow Molecular Weight Heparin. All Wales Medicines Strategy Group (AWMSG) Recommendations and advice
Low Molecular Weight Heparin All Wales Medicines Strategy Group (AWMSG) Recommendations and advice Starting Point Low Molecular Weight Heparin (LMWH): Inhibits factor Xa and factor IIa (thrombin) Small
More informationRIVAROXABAN. Consumer Information
RIVAROXABAN Consumer Information Rivaroxaban is a medicine that is used to increase the time it takes for blood to clot. It belongs to a class of medicines called anticoagulants, which are sometimes also
More informationPrimary prevention of venous thromboembolic events in adult patients who have undergone elective total hip or knee replacement surgery.
PRADAXA (DABIGATRAN ETEXILATE) PRESCRIBER GUIDE FOR PRIMARY PREVENTION OF VENOUS THROMBOEMBOLIC EVENTS (VTE) FOLLOWING ELECTIVE TOTAL HIP OR KNEE REPLACEMENT SURGERY This guide provides recommendations
More informationCDEC RECORD OF ADVICE
CDEC RECORD OF ADVICE RIVAROXABAN (Xarelto Bayer Inc.) Indication: Deep Vein Thrombosis Without Symptomatic Pulmonary Embolism This document summarizes the Canadian Drug Expert Committee (CDEC) response
More informationORAL ANTICOAGULANTS - RIVAROXABAN (XARELTO) FOR DEEP VEIN THROMBOSIS (DVT)
ORAL ANTICOAGULANTS - RIVAROXABAN (XARELTO) FOR DEEP VEIN THROMBOSIS (DVT) Information Leaflet Your Health. Our Priority. Page 2 of 6 What Are Anticoagulants And What Do They Do? This information leaflet
More informationMCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013. Anticoagulants
MCHENRY WESTERN LAKE COUNTY EMS SYSTEM OPTIONAL CE ADVANCED LEVEL (EMTP, PHRN, ECRN) August 2013 Anticoagulants Anticoagulants are agents that prevent the formation of blood clots. Before we can talk about
More information