Specialist recommendation (unlicensed)
Use with local trust approval.
Available from "special-order" manufacturers or specialist-importing companies.

2.5mg dose (higher doses are not indicated in hypertension)

Itracranial hypertension

• Specialist initiation

Supported by RICaD

unlicensed
Use with local trust approval.
Available from "special-order" manufacturers or specialist importing companies.

Anti Arrhythmic

NHS England commissioned

Injection (Secondary Care only)

Check availibility

• In line with NICE
• transfer to Primary care at 3 months following initiation by Heart Failure specialist supported by a RICaD. Click here to access RICaD

For existing patients only

For existing patients only.

For existing patients only

Secondary Care use only

Supported by a RICaD, see link below.

Specialist initiation

Supported by RICaD, see link below.

• Transfer to Primary Care supported by an ESCA.
• Click here for ESCA

  Single use in suspected DVT

  For all other indications.

The APC's view is that on clinical grounds, the status for certain indications approved by APC should be Amber Shared Care, supported by an ESCA. These indications are:

• Deep vein thrombosis (including paediatrics)
• Pulmonary embolism (including paediatrics)
• Intolerance/unsuitable for oral anticoagulants
• Certain cancer patients
• Injectable drug users
• Pregnant women
  HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED (ESCAs to be developed). This should not prevent individuals in primary care providing initial prescriptions in urgent situations e.g. pregnancy where there is a high thrombotic risk.

  For single dose in suspected DVT.


For all other indications.

The APC's view is that on clinical grounds, the status for certain indications approved by APC should be Amber Shared Care, supported by an ESCA. These indications are:

• Deep vein thrombosis (including paediatrics)
• Pulmonary embolism (including paediatrics)
• Intolerance/unsuitable for oral anticoagulants
• Certain cancer patients
• Injectable drug users
• Pregnant women
  HOWEVER, until the commissioning arrangements have been agreed to allow safe transfer of patient care, the status will remain RED (ESCAs to be developed). This should not prevent individuals in primary care providing initial prescriptions in urgent situations e.g. pregnancy where there is a high thrombotic risk.

Anticoagulants can only be initiated or recommended by clinicians/practitioners who have the necessary skills and experience in line with Local commissioning arrangements.

 Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. 

BSSE APC Primary Care Clinical Pathway for Arial Fibrillation Detection and Management
 
  Use following Hip and Knee surgery- full course of treatment supplied on discharge. 
 
  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.
RICaD: Apixaban in DVT/ PE

  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants. 

BSSE APC Primary Care Clinical Pathway for Arial Fibrillation Detection and Management

 For treating and for preventing recurrent DVT and 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
RICaD: Edoxaban in DVT/PE

  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants.

BSSE APC Primary Care Clinical Pathway for Arial Fibrillation Detection and Management
 
  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.
RICaD: Rivaroxaban in DVT /PE
 
  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.
RICaD: Rivaroxaban post ACS
 
 For preventing atherothrombotic events in people with coronary or peripheral artery disease use in line with NICE TA607
 
  Use following Hip and Knee surgery- full course of treatment supplied on discharge.

  Following diagnosis of AF- use in line with NICE. Initiation/ recommendation by a clinician who routinely initiates anticoagulants.  

BSSE APC Primary Care Clinical Pathway for Arial Fibrillation Detection and Management
 
  Use following Hip and Knee surgery- full course of treatment supplied on discharge. 
 
  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.
RICaD: Dabigatran in DVT / PE

Use in ACS,

The need for a RICaD has been removed (February 2018) following discussion at the APC. Rationale: clinicians are familiar with this drug for this indication. 

In line with NICE

Use post MI, need for RICaD removed January 2019

Palliative use only

Injection (Secondary Care only)

• Supported by a RICaD (in development)

• Supported by a RICaD (in development)