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.

11 October 2023

Surrey Heartlands Medicines Safety Committee (MSC)

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"

02 March 2022

Surrey Heartlands Integrated Care System Area Prescribing Committee (APC)

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).

25 May 2020

Surrey Heartlands Medicines Safety Committee (MSC)

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.

01 June 2016

Surrey Medicines Commissioners Group

Surrey Medicines Commissioning Group recommend that patients prescribed all types of anticoagulants (warfarin and NOACs) should be given an anticoagulant alert card to carry with them. For patients taking NOACs, the card should be annotated on the reverse in the “Therapeutic range (INR)” box with the words “not applicable” or “not required for this drug”. The cards are available for practices to order through usual NHS stationery supply routes. See an example of the Anticoagulant Alert Card in the document below

04 March 2020

Surrey & North West Sussex Area Prescribing Committee (formerly Prescribing Clinical Network)

The Surrey & North West Sussex Area Prescribing Committee have agree the updated guidance on calculating creatinine clearance for DOACs.

04 September 2019

Surrey & North West Sussex Area Prescribing Committee (formerly Prescribing Clinical Network)

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