|Therapeutic Area||Formulary Choices||Cost for 28|
(unless otherwise stated)
|Rationale for decision / comments|
|Parenteral anticoagulants||Related guidance: NICE Clinical Guideline CG92 (2010): Venous thromboembolism – reducing the risk
|20mg/0.2ml: £20.86 (10)|
40mg/0.4ml: £30.27 (10)
60mg/0.6ml: £39.26 (10)
80mg/0.8ml: £55.13 (10)
100mg/1ml: £72.30 (10)
120mg/0.8ml: £87.93 (10)
150mg/1ml: £99.91 (10)
|Enoxaparin is licensed for the prophylaxis and treatment of venous thromboembolism; treatment of unstable angina, non-Q-wave myocardial infarction, acute ST-segment elevation myocardial infarction (STEMI); prevention of thrombus formation in the extracorporeal circulation during haemodialysis.
NB. Dalteparin is licensed for treatment of symptomatic VTE and prevention of its recurrence, in patients with solid tumours
|Management of haemorrhage: haemorrhage is the main adverse effect of all oral anticoagulants. Checking the INR and omitting doses is essential. If the anticoagulant is stopped but not reversed, the INR should be checked again after 2 to 3 days to ensure that it is falling. The following recommendations apply to patients taking Warfarin and are based on the result of the INR and whether there is major or minor bleeding:
Major bleeding: stop Warfarin; give Phytomenadione (Vitamin K1) 5-10mg by slow intra-venous injection; give prothrombin complex concentrate (factors II, VII, IX and X) 30-50units/kg (or if no concentrate available) fresh frozen plasma 15ml/kg.
INR> 8.0, no bleeding or minor bleeding: stop Warfarin, re-start when INR < 5. If there are other risk factors for bleeding, give Phytomenadione (Vitamin K1) 500mcg by slow intra-venous injection or 5mg by mouth, (for partial reversal of anticoagulation give smaller oral doses of Phytomenadione e.g. 0.5mg - 2.5mg, using the intravenous p reparation orally); repeat dose of Phytomenadione if INR still too high after 24 hours.
See Chapter 9 for details of Phytomenadione preparations on the formulary.