Download Which Anticoagulant

Swansea AGPU-which anticoagulant VTE?
Which anticoagulant to prescribe:
Use antithrombotic agents with caution in patient with an increased bleeding risk such as;
o
o
o
o
Thrombocytopenia, if <100 not suitable for outpatient management
Recent cerebral haemorrhage or CNS surgery within 12 weeks
Uncontrolled hypertension (sustained readings of systolic >200mmHg, diastolic 110mmHg)
Lesions liable to substantial haemorrhage e.g. varices, active peptic ulceration, bleeding
haemorrhoids
RIVAROXABAN (XARELTO)
INCLUSION
o Patients confirmed as having a 1st DVT
o Vulnerable e.g. dementia, confusion,
learning difficulties, where having daily
injections and blood tests may be
detrimental to the patient’s health and
well being
o Needle phobic
o Dependant on WAST ambulance
transport to attend the hospital
o Dependant on public transport to
attend and has to take ≥3 buses/trains
o Enoxaparin or Warfarin Contraindicated
EXCLUSION
o Age ≤ 17 years
o Active cancer
o Pregnancy and breast feeding
o Creatinine Clearance <15ml/min
o Clinically significant active bleeding
o Hepatic disease associated with
coagulopathy and clinically relevant
bleeding risk including cirrhotic
patients with Child Pugh B & C
o With systemic azole-antimycotics e.g.
ketoconazole, itraconazole,
voriconazole and posaconazole
o HIV protease inhibitors e.g. ritonavir
o Known hypersensitivity to Rivaroxaban
or excipients
o Patient already prescribed Warfarin for
other indication
o Concomitant use with
Enoxaparin/Warfarin
o Recurrent DVT (whilst prescribing
cannot be done in Primary Care in
Swansea/NPT)
ENOXAPARIN (CLEXANE)
WARFARIN
INCLUSION
INCLUSION
o Active treatment for
o All patients who are
cancer
excluded from taking
o Solid tumour cancers
Rivaroxaban
o Intravenous drug
o Patients requiring
users or suspected
lifelong anticoagulation
alcohol misuse as
for recurrent VTE
there is an increased
(whilst Rivaroxaban
risk of non-compliance
cannot be prescribed in
o Strong possibility for
Primary Care in
non-compliance
Swansea/NPT)
EXCLUSION
o Known
hypersensitivity to
heparin or excipients
o Patient on
Rivaroxaban
EXCLUSION
o Pregnancy
o Active treatment for
cancer
o Solid tumour cancers
o Intravenous drug users
or suspected alcohol
misuse as there is an
increased risk of noncompliance
o Strong possibility for
non-compliance
o Known hypersensitivity
to heparin or excipients