Swansea AGPU-Which Anticoagulant VTE

Swansea AGPU-which anticoagulant VTE?

Which anticoagulant to prescribe:

Use antithrombotic agents with caution in patient with an increased bleeding risk such as;

o Thrombocytopenia, if <100 not suitable for outpatient management

o Recent cerebral haemorrhage or CNS surgery within 12 weeks

o Uncontrolled hypertension (sustained readings of systolic >200mmHg, diastolic 110mmHg)

o Lesions liable to substantial haemorrhage e.g. varices, active peptic ulceration, bleeding haemorrhoids

RIVAROXABAN (XARELTO) ENOXAPARIN (CLEXANE) WARFARIN

INCLUSION INCLUSION INCLUSION o Patients confirmed as having a 1st DVT o Active treatment for o All patients who are o Vulnerable e.g. dementia, confusion, cancer excluded from taking learning difficulties, where having daily o Solid tumour cancers Rivaroxaban injections and blood tests may be o Intravenous drug o Patients requiring detrimental to the patient’s health and users or suspected lifelong anticoagulation well being alcohol misuse as for recurrent VTE o Needle phobic there is an increased (whilst Rivaroxaban o Dependant on WAST ambulance risk of non-compliance cannot be prescribed in transport to attend the hospital o Strong possibility for Primary Care in o Dependant on public transport to non-compliance Swansea/NPT) attend and has to take ≥3 buses/trains o Enoxaparin or Warfarin Contraindicated EXCLUSION EXCLUSION o Known o Pregnancy EXCLUSION hypersensitivity to o Active treatment for o Age ≤ 17 years heparin or excipients cancer o Active cancer o Patient on o Solid tumour cancers o Pregnancy and breast feeding Rivaroxaban o Intravenous drug users o Creatinine Clearance <15ml/min or suspected alcohol o Clinically significant active bleeding misuse as there is an o Hepatic disease associated with increased risk of non- coagulopathy and clinically relevant compliance bleeding risk including cirrhotic o Strong possibility for patients with Child Pugh B & C non-compliance o With systemic azole-antimycotics e.g. o Known hypersensitivity ketoconazole, itraconazole, to heparin or excipients voriconazole and posaconazole o HIV protease inhibitors e.g. ritonavir o Known hypersensitivity to Rivaroxaban or excipients o Patient already prescribed Warfarin for other indication o Concomitant use with Enoxaparin/Warfarin o Recurrent DVT (whilst prescribing cannot be done in Primary Care in Swansea/NPT)