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Bedfordshire and Luton Joint Formulary
Bedfordshire Hospitals NHS Foundation Trust
Bedfordshire, Luton and Milton Keynes ICB
Formulary Chapter: 2 - Cardiovascular system 
Notes:

Any drug not listed on the Formulary should be considered Non-Formulary - Not recommended for prescribing
Links:
Hypertension Resources For Health Professionals NICE guideline NG136 Hypertension in adults: diagnosis and management
02.08.02 Oral anticoagulants
MHRA Drug Safety Uodate: Direct-acting oral anticoagulants (DOACs): reminder of bleeding risk, including availability of reversal agents (June 2020) Trust Guidelines: Reversal of anticoagulation and management of bleeding in adult patients on either warfarin, nonVitamin K oral anticoagulants (NOACs) or heparin (2017)

Apixaban 2.5mg & 5mg tablets
( Film Coated Tablets)

GREEN
First Choice

First choice for new initiations

 

Refer to NICE TA275/TA341 AND anti-coagulation guidelines.

N.B. not advised to prescribe at extremes of bodyweight (120kg).

Compared to apixaban exposure in subjects with body weight of 65 to 85 kg, body weight > 120 kg was associated with approximately 30% lower exposure and body weight < 50 kg was associated with approximately 30% higher exposure. (from manufacturers SPC).

N.B. apixaban has not been studied in patients with prosthetic heart valves and its use is not recommended in these patients (see MHRA DSU Oct 18 link under rivaroxaban).

 

Entry reviewed: February 2024

BNF BNFc SPC
MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome NICE TA275: Stroke and systemic embolism (prevention, non-valvular atrial fibrillation) - apixaban NICE TA341: Apixaban for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism

Warfarin 1mg (brown), 3mg (blue) & 5mg (pink)
(Tablets)

GREEN
Formulary

Ensure dose is written in patient's yellow book upon discharge and anti-coagulation clinic appointment made.

BNF BNFc SPC
Warfarin: be alert to the risk of drug interactions with tramadol

Edoxaban 30mg & 60mg (Lixiana®)
( Tablets)

GREEN
Formulary

Refer to NICE TA354/TA355 AND anti-coagulation guidelines.

N.B. edoxaban has not been studied in patients with prosthetic heart valves and its use is not recommended in these patients (see MHRA DSU Oct 18 link under rivaroxaban).

BNF BNFc SPC
MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome NICE TA354: Edoxaban for treating and for preventing deep vein thrombosis and pulmonary embolism NICE TA355: Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation

Dabigatran 75mg & 110mg (Pradaxa®)
(Capsules)

GREEN
Formulary

Refer to NICE TA157/TA249/TA327 AND anti-coagulation guidelines.

N.B. dabigatran is contraindicated in patients with prosthetic heart valves requiring anticoagulant treatment. See MHRA Drug Safety Update Oct 2018 (link in rivaroxaban section below).

BNF BNFc SPC
MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome NICE TA157: VTE prevention post hip / knee surgery - dabigatran NICE TA249: Dabigatran for Stroke prevention in AF NICE TA327: Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism

Rivaroxaban 10mg, 15mg & 20mg (Xarelto®)
( Film Coated Tablets)

GREEN
Formulary

Refer to NICE TA256/TA261/TA287/TA335 AND anti-coagulation guidelines.

L&D: 10mg tablets also approved for 2nd line use in needle-phobic patients for thromboprophylaxis in patients with temporary limb immobilisation by the emergency department doctors (dose = 10mg once daily).

Rivaroxaban is not authorised for thromboprophylaxis in patients with prosthetic heart valves, including patients who have undergone TAVR, and should not be used in such patients. See MHRA update below.

BNF BNFc SPC
MHRA DSU June 2019: Direct-acting oral anticoagulants (DOACs): increased risk of recurrent thrombotic events in patients with antiphospholipid syndrome MHRA DSU Oct 2018: Rivaroxaban (Xarelto▼) after transcatheter aortic valve replacement: increase in all-cause mortality, thromboembolic and bleeding events in a clinical trial NICE TA256: Rivaroxaban for AF NICE TA261: Rivaroxaban for treatment of DVT NICE TA287: Rivaroxaban for treating PE and preventing recurrent venous thromboembolism NICE TA335: Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome

Rivaroxaban 2.5mg (Xarelto®)
( Film Coated Tablets)

Amber SPA
Formulary

Refer to NICE TA607

For specialist initiation only

BNF BNFc SPC
NICE TA607 Rivaroxaban for preventing atherothrombotic events in people with coronary or peripheral artery disease
02.08.02 Stroke prevention in AF
02.08.02 Atrial Fibrillation
02.08.02 VTE treatment
02.08.02 VTE prophylaxis in hip/knee surgery
02.08.02 VTE Prophylaxis
Classifications
GREEN
May be initiated in any care setting
Amber SPA
Specialist to advise therapy and provide first 28 days supply, continuation in Primary Care
Amber SPIS
Specialist to initiate and stabilise medicine prior to continuation in Primary Care
SCG
To be prescribed as per Shared Care Guidance. If no SCG in place status reverts to red.
RED
Red medicines are designated as specialist only medicines which should only be prescribed by a specialist, usually within secondary care (either due to the requirement for specialist knowledge, long-term monitoring requirements, or restrictions that mean medicine supplies are only available to hospitals).
DNP
A decision has been made either locally and/or nationally not to routinely commission this preparation. Do not prescribe.
SELF
To be purchased over the counter. May be prescribed for chronic, long term conditions or on admission to hospital if essential.