CLINICAL GUIDELINE FOR RESTARTING OF ANTIPLATELET / ANTICOAGULATION MEDICATIONS Aim/Purpose of this Guideline

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1 CLINICAL GUIDELINE FOR RESTARTING OF ANTIPLATELET / ANTICOAGULATION MEDICATIONS Aim/Purpose of this Guidelie This guidelie is desiged to safely maage the restartig of the followig medicatios. The aim is to miimise the risk of bleedig after a whilst miimisig the risk of thromboembolic complicatios that may occur from cotiued cessatio of some of these medicatios. Page 1 of 9

2 1. The Guidace 1.1 The guidace is summarized below. DRUG INDICATIO N LHC LHC? PCI / PWS Aspiri Atiplatelet cotiue If steted lifelog Clopidogrel Atiplatelet cotiue If steted - to Ticagrelor be take for Prasugrel betwee Warfari: Moderate to high risk ( 4 or ay metal valve) Low risk 1-12 moths Aticoagulat cotiue LMWH o the the. Cotiue LMWH util a cotiue PCI / Rotablatio PPM / ICD CRT-D CRT-P Page 2 of 9 Ablatio: Narrow complex tachy / SVT/ AVNRT/ WPW VT Stimulatio Atrial flutter ablatio AV ode ablatio with PPM i-situ AV ode ablatio with PPM implat lifelog cotiue cotiue cotiue cotiue cotiue cotiue cotiue To be take for betwee 1-12 moths LMWH o the the. Cotiue LMWH util a cotiue cotiue cotiue cotiue cotiue cotiue cotiue cotiue cotiue Patiet specific - Liaise with Dr. Slade day after day after cotiue cotiue cotiue cotiue cotiue cotiue cotiue

3 Daltepari/Frag mi Eoxapari/Cle xae Treatmet dose >10,000IU LMWH First dose 24hrs after First dose 24hrs after First dose 24hrs after cotiue cotiue cotiue cotiue cotiue cotiue cotiue cotiue cotiue cotiue Prophylactic dose <10,000IU Rivaroxaba Apixaba Moderate to high risk ( 4 or ay metal valve) Low risk Dabigatra Moderate to high risk ( 4 or ay metal valve) New oral aticoagulat - Direct factor Xa ihibitors Aticoagulat - Direct thrombi ihibitor cotiue LMWH o the the. Cotiue LMWH util a cotiue hrs post cotiue LMWH o the the. Cotiue LMWH util a hrs post cotiue cotiue cotiue cotiue cotiue cotiue cotiue hrs post hrs post hrs post cotiue cotiue cotiue hrs post cotiue cotiue cotiue cotiue cotiue cotiue cotiue Page 3 of 9

4 Low risk Fodapariux Atithromboti c- Idirect factor Xa ihibitor LMWH o the the. Cotiue LMWH util a cotiue hrs post LMWH o the the. Cotiue LMWH util a hrs post hrs post hrs post hrs post cotiue cotiue cotiue hrs post cotiue cotiue cotiue Page 4 of 9

5 1. Moitorig compliace ad effectiveess This part must provide iformatio o the processes ad methodology for moitorig compliace with, ad effectiveess of, the policy usig the table below. Elemet to be moitored Lead Tool Frequecy Reportig arragemets Actig o recommedatios ad Lead(s) Chage i practice ad lessos to be shared All elemets to be moitored Cardiology Departmet Review of case otes, usig the guidelies as the audit stadard. Oe year after implemetatio to complete first audit. Thereafter frequecy will deped o our compliace. Reportig ito Cardiology Goverace The Cardiology Departmet Goverace ad Audit leads will be resposible for this. The report will be dissemiated ad a expectatio to implemet ay recommedatios of chage immediately The recommeded actios will be cascaded to the ursig ad medical staff ivolved i the cliical maagemet of these patiets, at presetatios to the relevat departmetal meetigs. 2. Equality ad Diversity 2.1. This documet complies with the Royal Corwall Hospitals NHS Trust service Equality ad Diversity statemet which ca be foud i the 'Equality, Diversity & Huma Rights Policy' or the Equality ad Diversity website Equality Impact Assessmet The Iitial Equality Impact Assessmet Screeig Form is at Appedix 2. Page 5 of 9

6 Appedix 1. Goverace Iformatio Documet Title Date Issued/Approved: Feb 2015 Date Valid From: 15/07/2015 Date Valid To: 15/07/2018 Directorate / Departmet resposible (author/ower): Sia Pelto Cardiology flow cocoordiator Cotact details: Brief summary of cotets Suggested Keywords: Target Audiece Executive Director resposible for Policy: Date revised: This documet replaces (exact title of previous versio): Approval route (ames of committees)/cosultatio: Divisioal Maager cofirmig approval processes Name ad Post Title of additioal sigatories Name ad Sigature of Divisioal/Directorate Goverace Lead cofirmig approval by specialty ad divisioal maagemet meetigs This guidelie is desiged to safely maage the restartig of the followig medicatios. The aim is to miimise the risk of bleedig durig/after a whilst miimisig the risk of thromboembolic complicatios that may occur from cessatio of some of these medicatios. Atiplatelet,, bleedig RCHT PCH CFT KCCG Medical Director New New documet Cardiology Goverace & Medicie Goverace Board DGM Medicie Not Required {Origial Copy Siged} Name: Jo Stratto Page 6 of 9

7 Sigature of Executive Director givig approval Publicatio Locatio (refer to Policy o Policies Approvals ad Ratificatio): Documet Library Folder/Sub Folder Liks to key exteral stadards Related Documets: Traiig Need Idetified? {Origial Copy Siged} Iteret & Itraet Itraet Oly Cliical / Cardiology Goverace Team ca advise N/A No Versio Cotrol Table Date Versio No Feb 2015 V1.0 Iitial Issue Summary of Chages Chages Made by (Name ad Job Title) Sia Pelto Cardiology Flow coordiator All or part of this documet ca be released uder the Freedom of Iformatio Act 2000 This documet is to be retaied for 10 years from the date of expiry. This documet is oly valid o the day of pritig Cotrolled Documet This documet created followig the Royal Corwall Hospitals NHS Trust Policy o Documet Productio. It should ot be altered i ay way without the express permissio of the author or their Lie Maager. Page 7 of 9

8 Appedix 2. Iitial Equality Impact Assessmet Form Name of Name of the strategy / policy /proposal / service fuctio to be assessed (hereafter referred to as policy) (Provide brief descriptio): Directorate ad service area: Is this a ew or existig Policy? Cardiology - Medicie New Name of idividual completig Telephoe: assessmet: Sia Pelto 1. Policy Aim* This guidelie is desiged to safely maage the discotiuatio of Who is the strategy / the followig medicatios. The aim is to miimise the risk of policy / proposal / bleedig durig/after a whilst miimisig the risk of service fuctio thromboembolic complicatios that may occur from cessatio of aimed at? some of these medicatios. 2. Policy Objectives* This guidelie is desiged to safely maage the discotiuatio of the followig medicatios. The aim is to miimise the risk of bleedig durig/after a whilst miimisig the risk of thromboembolic complicatios that may occur from cessatio of 3. Policy iteded Outcomes* some of these medicatios. To stadardise care, early, appropriate ad timely itervetios, better educatio ad reduce morbidity ad mortality. 4. *How will you measure the outcome? 5. Who is iteded to beefit from the policy? 6a) Is cosultatio required with the workforce, equality groups, local iterest groups etc. aroud this policy? Audit Patiets There is o eed for discussio with equality groups, local iterest groups or workforce as the guidelies are ot relevat i that respect. b) If yes, have these *groups bee cosulted? C). Please list ay groups who have bee cosulted about this. 7. The Impact Please complete the followig table. Are there cocers that the policy could have differetial impact o: Equality Strads: Yes No Ratioale for Assessmet / Existig Evidece Age Page 8 of 9

9 Sex (male, female, trasgeder / geder reassigmet) Race / Ethic commuities /groups Disability - Learig disability, physical disability, sesory impairmet ad metal health problems Religio / other beliefs Marriage ad civil partership Pregacy ad materity Sexual Orietatio, Bisexual, Gay, heterosexual, Lesbia You will eed to cotiue to a full Equality Impact Assessmet if the followig have bee highlighted: You have ticked Yes i ay colum above ad No cosultatio or evidece of there beig cosultatio- this excludes ay policies which have bee idetified as ot requirig cosultatio. or Major service redesig or developmet 8. Please idicate if a full equality aalysis is recommeded. No 9. If you are ot recommedig a Full Impact assessmet please explai why. The policy is equally applicable to all groups. Sigature of policy developer / lead maager / director Date of completio ad submissio Names ad sigatures of members carryig out the Screeig Assessmet Keep oe copy ad sed a copy to the Huma Rights, Equality ad Iclusio Lead, c/o Royal Corwall Hospitals NHS Trust, Huma Resources Departmet, Kowledge Spa, Truro, Corwall, TR1 3HD A summary of the results will be published o the Trust s web site. Siged Date Page 9 of 9

Loading Dose Worksheet for Oral Amiodarone

Loading Dose Worksheet for Oral Amiodarone This applies to adult patients only Key: General Notes ED/MAU/SRU/Acute GP/Amb-Care GP/SWASFT In-patient wards Start Prescribe as per loading dose worksheet below End 1. Aim/Purpose of this Guideline 1.1.