Specialist initiation for the treatment and secondary prevention of DVT and/or PE - use in line with NICE and supported by RICaD

Second choice following diagnosis of AF - use in line with NICE

• Anticoagulant Initiation Flowchart for Anticoagulation in Atrial Fibrillation

Use following hip and knee surgery - full course of treatment supplied on discharge

Hospital use only

Following diagnosis of AF – use in line NICE and toolkit, initiation/recommendation by haematologist, transfer to GP with RICaD. For the treatment and secondary prevention of DVT and/or PE - use in line with NICE. Initiation/recommendation by haematologist, transfer to GP with RICaD

Adults only

Use following hip and knee surgery – full course of treatment supplied on discharge

Hospital use only

First choice following a diagnosis of AF - use in line with NICE

• Anticoagulant Initiation Flowchart for Anticoagulation in Atrial Fibrillation

Specialist initiation - For the treatment and secondary prevention of DVT and/or PE - use in line with NICE and supported by RICaD

• Anticoagulant Initiation Flowchart for Anticoagulation in Atrial Fibrillation

For all other indications. The APC's view is that on clinical grounds, the status for certain indications approved by APC should be amber, supported by an ESCA. However, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain red (ESCAs to be developed). 

Hospital use only

Hospital use only

Hospital use only

When rapid reversal of Dabigatran anticoagulant effect is required

Hospital use only

• Amber - specialist initation following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants
• Amber - specialist initation for the treatment and secondary prevention of DVT and/or PE - use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD
• Amber - specialist initiation for preventing adverse outcomes after acute management of ACS use in line with NICE TA335. Initiation/recommendation by a clinician who routinely initiates anticoagulants. Where this is not the patient's GP, transfer to GP should be with the support of RICaD

BSSE APC preferred agent. This recommendation must only be taken into account after a patient and prescriber have discussed all treatment options (including warfarin) and only if they have no preference about which medicine they want to use.

Red use following hip and knee surgery – full course of treatment supplied on discharge

Hospital use only

Hospital use only

First choice. BSSE APC preferred agent. This recommendation must only be taken into account after a patient and prescriber have discussed all treatment options (including warfarin) and only if they have no preference about which medicine they want to use. To be initiated by those who have the appropriate skills and experience.

Use should be in line with local commissioning arrangements - for BCC CCG - Anticoagulation AQP. Ensure that patients prescribed anticoagulants receive appropriate verbal and written information at the start of therapy, at hospital discharge, on the first anticoagulant clinic appointment, and when necessary throughout the course of their treatment (NPSA Alert 18)