Apixaban - Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE)

The Surrey Heartlands integrated care system Area Prescribing Committee (APC) have made the following recommendations for the implementation of the NICE guideline - Venous Thromboembolic Diseases: diagnosis, management and thrombophilia testing (NG158):

1. Apixaban, rivaroxaban, edoxaban and dabigatran were assigned a BLUE (no information sheet) traffic light status with:

• Apixaban or rivaroxoaban for initiation in most patients because they do not require initial treatment with 5 days of LMWH
• Edoxaban and dabigatran reserved for those few patients who are not clinically suitable for apixaban or rivaroxaban eg those with excellent renal function where dabigatran is the best choice.

2. Specialist to prescribe the first month of treatment
3. Specialist to request transfer of prescribing to primary care using the transfer of prescribing document (see below)
4. The NICE & South West London pathways for VTE diagnosis and management are available below for reference

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.