Guidelines : Atrial fibrillation

The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

Co-prescribing of antiplatelets / anticoagulants may be requested by a specialist in a number of scenarios.

The Medicines safety Committee have produced an aide memoire to list the information that must be available to the primary care clinican  to support the safe prescribing of dual / triple therapies in primary care.

See below for document: "Dual antiplatelet-anticoagulant therapy - Aide memoire for managing hospital requests"

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey Heartlands CCG Medicines Safety Group have produced a two page summary information sheet on Assessing Renal Function for Drug Dose Adjustments in Primary  Care.  This is based on the information in the MHRA safety alert: Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions October 2019.

The Surrey & North West Sussex Area Prescribing Committee have agree the updated guidance on calculating creatinine clearance for DOACs. See below. The DOAC selection tool updated in October 2019, remains unchanged.

A clinical trial has shown an increased risk of recurrent thrombotic events associated with rivaroxaban compared with warfarin, in patients with antiphospholipid syndrome and a history of thrombosis. Other direct-acting oral anticoagulants (DOACs) may be associated with a similarly increased risk.
Please see Thrombosis risk safety alert information below

The September APC also agreed the use of a DOAC patient information leaflet and a counselling checklist for use by healthcare professionals when patients commence DOAC therapy - see documents below