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  6. Antiplatelet or Anticoagulant Treatment and Outpatient Gynaecological Procedures (712)
Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. 

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Antiplatelet or Anticoagulant Treatment and Outpatient Gynaecological Procedures (712)

Please report any inaccuracies or issues with this guideline using our online form

Factor Xa inhibitors Apixaban (Eliquis®), Edoxaban (Lixiana®) and Rivaroxiban (Xarelto®) are the preferred anticoagulant therapy for treatment of venous thromboembolism and non-valvular atrial fibrillation (AF). Within NHS GG&C, edoxaban is the treatment of choice for AF and Apixaban for pulmonary embolism. They are direct oral anticoagulants (DOACs) and are Factor Xa inhibitors. An additional DOAC, dabigatran (a direct thrombin inhibitor), is also in use within NHS GG&C in a small number of patients.

DOACs are in tablet form and are taken orally once (rivaroxaban, edoxaban) or, twice (apixaban, dabigatran) daily. Rivaroxaban may also be taken twice daily in the first 21 days as a loading dose. They have a relatively short half life (of 8-12 hours) but this may be longer in the presence of renal impairment (creatinine clearance, (CrCl) <30ml/min). The CrCl is the preferred measure of renal function (rather than eGFR) when managing DOACs (see Appendix A for the NHS GG&C creatinine clearance calculator). With the exception of dabigatran (for which there is an antidote, Praxbind® (idarucizumab)) the anticoagulant effect of DOACs cannot be easily reversed and as such emergency surgery or procedures may be challenging to manage.

This guideline will discuss the management of patients taking anticoagulants (warfarin or DOACs) and anti-platelet agents (e.g. clopidogrel) when undergoing elective gynaecological procedures, according to their risk of haemorrhage.

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Editorial Information

Last reviewed: 04/02/2020

Next review date: 01/02/2025

Author(s): Dr Joy Simpson.

Approved By: Gynaecology Clinical Governance Group

Document Id: 712