Oral anticoagulants (Formulary)

Important: Formulation and dosage details

Formulation:

Tablets 2·5mg, 5mg

Dosage:

• Prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation and at least one risk factor, eg, previous stroke or transient ischaemic attack, symptomatic heart failure, diabetes, hypertension, or age (75 years and over)
• Prophylaxis of venous thromboembolism following knee replacement surgery
• Prophylaxis of venous thromboembolism following hip replacement surgery
• Treatment of deep-vein thrombosis, treatment of pulmonary embolism
• Prophylaxis of recurrent deep-vein thrombosis, prophylaxis of recurrent pulmonary embolism.

Important: Formulation and dosage details

Formulation:

Tablets 15mg, 30mg, 60mg

Dosage:

• Prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation, in patients with at least one risk factor (such as congestive heart failure, hypertension, aged 75 years and over, diabetes mellitus, previous stroke or transient ischaemic attack)
• Treatment of deep-vein thrombosis
• Prophylaxis of recurrent deep-vein thrombosis
• Treatment of pulmonary embolism
• Prophylaxis of recurrent pulmonary embolism.

Important: Formulation and dosage details

Formulation:

Capsules 110mg, 150mg

• Patient must be able to swallow capsule whole, as opening or chewing the capsule increases oral bioavailability and bleeding risk.
• Unsuitable for storage in monitored dosage systems (MDS).

Dosage:

• Prophylaxis of stroke and systemic embolism in non-valvular atrial fibrillation and with one or more risk factors such as previous stroke or transient ischaemic attack, symptomatic heart failure, age ≥ 75 years, diabetes mellitus, or hypertension
• Prophylaxis of venous thromboembolism following total knee replacement surgery
• Prophylaxis of venous thromboembolism following total hip replacement surgery
• Treatment of deep-vein thrombosis
• Treatment of pulmonary embolism
• Prophylaxis of recurrent deep-vein thrombosis
• Prophylaxis of recurrent pulmonary embolism.

Important: Formulation and dosage details

Formulation:

Tablets 10mg, 15mg, 20mg

• To be taken with food.

Dosage:

• Prophylaxis of stroke and systemic embolism in patients with non-valvular atrial fibrillation and with at least one of the following risk factors: congestive heart failure, hypertension, previous stroke or transient ischaemic attack, age ≥ 75 years, or diabetes mellitus
• Prophylaxis of venous thromboembolism following knee replacement surgery
• Prophylaxis of venous thromboembolism following hip replacement surgery
• Treatment of deep-vein thrombosis
• Treatment of pulmonary embolism
• Prophylaxis of recurrent deep-vein thrombosis
• Prophylaxis of recurrent pulmonary embolism
• Multiple myeloma to counteract the prothrombotic effect of immune modulating drugs (specialist haematology use only) off-label, 10mg once daily

Important: Formulation and dosage details

Formulation:

Tablets 2∙5mg (specialist initiation only as per CAD/PAD guideline)

Dosage:

As per SMC 2128: Co-administered with acetylsalicylic acid for the prevention of atherothrombotic events in adult patients with:

• coronary artery disease, or
• symptomatic peripheral artery disease at high risk of ischaemic events.

SMC restriction: use in patients with stable coronary artery disease that does not require dual antiplatelet therapy. 

• Prophylaxis of atherothrombotic events following an acute coronary syndrome with elevated cardiac biomarkers (in combination with aspirin alone or aspirin and clopidogrel)
• Prophylaxis of atherothrombotic events in patients with coronary artery disease or symptomatic peripheral artery disease at high risk of ischaemic events (in combination with aspirin).

Guideline:

CAD/PAD guideline

Important: Formulation and dosage details

Formulation:

Tablets 500 micrograms, 1mg, 3mg

Dosage:

• Prophylaxis of embolisation in rheumatic heart disease and atrial fibrillation
• Prophylaxis after insertion of prosthetic heart valve
• Prophylaxis and treatment of venous thrombosis and pulmonary embolism
• Transient ischaemic attacks.

Refer to BNF for contraindications or complications.

• There is a wide range of drug and dietary interactions with warfarin which should be carefully considered, refer to BNF.
• Where antibiotics are required, note that many antibiotics interact with warfarin. Ideally patients should be advised and the INR should be checked at baseline and rechecked three days after starting a course of antibiotics, regardless of the length of the antibiotic course.
• On discharge from hospital, to ensure that anticoagulant monitoring can be provided safely, information on the anticipated duration of anticoagulation, target INR, indication and current dose of warfarin must be provided. This information is contained in a form within the Immediate Discharge Document (IDD) system, eg IDL, and should be emailed to whoever is responsible for the ongoing management of the patient’s anticoagulation.

Guidance:

• Warfarin anticoagulant guidance
• For in-patients refer to additional guidance on the NHS Highland In-patient Oral Anticoagulant Prescription Chart (NHS Highland intranet access required)
• Metal valves: refer to BCSH Guidelines on oral anticoagulation with warfarin – 4^thedition.

Important: Formulation and dosage details

Formulation:

Tablets 5mg (Non-Formulary, not recommended)

No longer recommended for the general population to avoid confusion with the 500 microgram (0·5mg) tablet. There may however be some patients whose risk/benefit is to continue to use the 5mg tablet.