Therapeutic AreaFormulary ChoicesCost for 28
(unless otherwise stated)
Rationale for decision / comments
2.8.2 Oral anticoagulants
CoumarinsManagement of patients on warfarin should be in line with the National Enhanced Service specification.
Refer to National Patient Safety Agency (NPSA) guidance on safe practices around use of anticoagulants.
Warfarin500mcg tablets: £1.58
1mg tablets: £0.76
3mg tablets: £0.79
5mg tablets: £0.82
Warfarin is included in the formulary for the following indications (with target INRs):
• Atrial fibrillation: target INR = 2.5
• Treatment of DVT or PE: target INR = 2.5
• Recurrent DVT or PE: target INR = 3.5
• Mechanical prosthetic heart valves: target INR dependent on type and location of valve. Generally a target INR of 3 is recommended for mechanical aortic valves and a target INR of 3.5 for mechanical mitral valves
New Oral Anticoagulants
(NOACs)
For primary care prescribing see NICE guidance on:
Dabigatran - Dabigatran for the prevention of stroke and systemic embolism in atrial fibrillation– TA249
Dabigatran - HOSPITAL ONLY Dabigatran etexilate for the prevention of venous thromboembolism after hip or knee replacement surgery in adults (TA157)
Dabigatran - Dabigatran for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism – TA327
Rivaroxaban – Rivaroxaban for the prevention of stroke and systemic embolism in people with atrial fibrillation (TA256)
Rivaroxaban – HOSPITAL ONLY Rivaroxaban for the prevention of venous thromboembolism after total hip or total knee replacement in adults (TA170)
Rivaroxaban – Rivaroxaban for the treatment of deep vein thrombosis and prevention of recurrent deep vein thrombosis and pulmonary embolism (TA261)
Rivaroxaban – Rivaroxaban for treating pulmonary embolism and preventing recurrent venous thromboembolism (TA287)
Apixaban – Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (TA275)
Apixaban - HOSPITAL ONLY Apixaban for the prevention of venous thromboembolism after total hip or knee replacement in adults (TA245)
Apixaban - Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism (TA341)
Edoxaban - Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation (TA355)
Edoxaban - Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism (TA354)

Primary prevention of venous thromboembolic events in adult patients after elective total hip replacement surgery or total knee replacement surgery is hospital prescribing only: (see NICE TA157 Dabigatran, NICE TA170 Rivaroxaban, and NICE TA245 Apixaban. The full course should be supplied when the procedure is carried out & there should be no requirement to prescribe for either 10mg rivaroxaban or 75mg dabigatran in primary care. (RED Indication in TLG)
Direct thrombin InhibitorDabigatran75mg capsules: £51.00 (60)
75mg only for after
elective knee & hip surgery in some patients* – RED DRUG

110mg capsules:£51.00 (60)
150mg capsules:£51.00 (60)
Dabigatran is included for
• Prevention of stroke & systemic embolism for people with non-valvular atrial fibrillation where patients fit the criteria in NICE TA249. See Implementation priorities.
• Treatment of DVT and PE, and prevention of recurrent DVT and PE in adults. See TA327
See note above for use post elective hip & knee replacement (NICE TA157).
* Link to SPC
Specific reversal agent for dabigatrinIdarucizumab (Praxbind®)2.5g/50ml solution for injection
Price to be confirmed
For secondary care use only: RED DRUG

Praxbind is a specific reversal agent for dabigatran and is indicated in adult patients treated with Pradaxa (dabigatran etexilate) when rapid reversal of its anticoagulant effects is required:
• For emergency surgery/urgent procedures
• In life-threatening or uncontrolled bleeding.
Direct inhibitor of activated Factor XRivaroxaban10mg tablets: £54.00 (30)
10mg only for after
elective knee & hip
surgery – RED DRUG

15mg tablets: £50.40 (28)
20mg tablets: £50.40 (28)
• For the prevention of stroke & systemic embolism for people with non-valvular atrial fibrillation in accordance with NICE TA256. See below for implementation priorities
and;
• For treating and preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) for adults in accordance with NICE TA261
and;
• An option for treating pulmonary embolism and preventing recurrent deep vein thrombosis and pulmonary embolism in adults in accordance with NICE TA287
and;
• As an option to treat signs and symptoms of DVT
and;
• 15mg and 20mg strengths for prevention of cardiovascular disease in patients with atrial fibrillation undergoing cardioversion

See note above for use post elective hip & knee replacement (NICE TA170)

Apixaban2.5mg tablets: £57.00 (60)

5mg tablets: £53.20 (56)
Apixaban is included for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation, with one or more risk factors, such as prior stroke or transient ischaemic attack (TIA); age ≥ 75 years;

See note above for use post elective hip & knee replacement (NICE TA245).

For the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism NICE TA341 (June 2015)
Edoxaban15mg tablets: £18.50 (10)
Only to be used when switching from 30mg to VKA
30mg tablets: £49.00 (28)
60mg tablets: £49.00 (28)
Edoxaban is included for prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF), with one or more risk factors, such as congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischaemic attack (TIA). See NICE TA355 (Sept 15)

Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE in adults. NICE TA354

 

NOAC decision aid
NOAC decision aid 2
 
NOAC decision aid 3
Reducing the risk of stroke in AF NICE CG180