page168
PHENINDIONE
Indications
prophylaxis of embolisation in rheumatic
heart disease and atrial fibrillation;
prophylaxis after
insertion of prosthetic heart valve; prophylaxis and
treatment of venous thrombosis and pulmonary
embolism
Cautions
see under Warfarin Sodium;
interactions:
Appendix 1 (phenindione)
Contra-indications
see under Warfarin Sodium
Hepatic impairment
see notes above
Renal impairment
see notes above
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see under Warfarin Sodium;
also hyper-
sensitivity reactions including exfoliative dermatitis,
exanthema,
fever,
leucopenia,
agranulocytosis,
eosinophilia,
and renal damage;
micro-adenopathy
and urine coloured pink or orange
Dose
. 200 mg on day 1;
100 mg on day 2,
then adjusted
according to response; maintenance dose usually 50–
150 mg daily
Phenindione
(Non-proprietary) A
Tablets
,
phenindione 10 mg,
net price 28-tab pack =
£21.10;
25 mg,
28-tab pack = £27.36;
50 mg,
28-tab
pack = £32.33.
Label:
10,
anticoagulant card,
14,
(urine pink or orange)
Dabigatran etexilate
Dabigatran etexilate,
a direct
thrombin inhibitor,
is
given orally for prophylaxis of
venous thromboembo-
lism in adults after total
hip replacement or total
knee
replacement surgery; see Prophylaxis of Venous Throm-
boembolism,
p.
140.
Dabigatran etexilate has a rapid
onset of action and does not require therapeutic mon-
itoring.
The most common side-effect is haemorrhage
and patients should be monitored for signs of bleeding
or
anaemia;
treatment
should be stopped if
severe
bleeding occurs.
NICE guidance
Dabigatran etexilate for the prevention of
venous thromboembolism after hip or knee
replacement surgery in adults (September
2008)
Dabigatran etexilate is an option for the prophylaxis
of venous thromboembolism in adults after total hip
replacement or total knee replacement surgery.
DABIGATRAN ETEXILATE
Indications
see notes above
Cautions
see notes above; also elderly; body-weight
less than 50 kg;
recent surgery;
anaesthesia with
postoperative indwelling epidural catheter (risk of
paralysis—give initial dose at least 2 hours after
catheter removal and monitor neurological signs);
bacterial endocarditis (increased risk of bleeding);
bleeding disorders; active gastro-intestinal ulceration;
concomitant use of drugs that increase risk of bleed-
ing;
interactions:
Appendix 1 (dabigatran etexilate)
Contra-indications
active bleeding;
impaired hae-
mostasis
Hepatic impairment
avoid in severe liver disease,
especially if prothrombin time already prolonged
Renal impairment
reduce initial dose to 75 mg and
subsequent doses to 150 mg once daily if eGFR 30–
50 mL/minute/1.73 m
2
;
reduce dose to 75 mg once
daily if eGFR 30–50 mL/minute/1.73 m
2
and patient
receiving concomitant treatment with verapamil;
avoid if eGFR less than 30 mL/minute/1.73 m
2
Pregnancy
manufacturer advises avoid—toxicity in
animal
studies
Breast-feeding
manufacturer advises avoid—no
information available
Side-effects
haemorrhage—see notes above;
less
commonly
hepatobiliary disorders
Dose
. Prophylaxis of venous thromboembolism following
total knee replacement surgery,
ADULT
over 18 years,
110 mg (
ELDERLY
over 75 years, 75 mg) 1–4 hours after
surgery,
then
220 mg (
ELDERLY
over 75 years,
150 mg)
once daily for 9 days
. Prophylaxis of venous thromboembolism following
total hip replacement surgery,
ADULT
over 18 years,
110 mg (
ELDERLY
over 75 years, 75 mg) 1–4 hours after
surgery,
then
220 mg (
ELDERLY
over 75 years,
150 mg)
once daily for 27–34 days
Note
Max.
150 mg daily with concomitant
amiodarone or
verapamil
Pradaxa
c
(Boehringer Ingelheim) T A
Capsules
,
blue/ivory,
dabigatran etexilate (as mesi-
late) 75 mg,
net price 10-cap pack = £21.00,
60-cap
pack = £126.00; 110 mg 10-cap pack = £21.00, 60-cap
pack = £126.00.
Label:
25
Rivaroxaban
Rivaroxaban, a direct inhibitor of activated factor X,
is
given orally for prophylaxis of
venous thromboembo-
lism in adults after hip or knee replacement surgery; see
Prophylaxis of Venous Thromboembolism,
p.
140.
Riv-
aroxaban does not require therapeutic monitoring.
The
common side-effects are nausea and haemorrhage, and
patients should be monitored for signs of
bleeding or
anaemia; treatment should be stopped if severe bleeding
occurs.
NICE guidance
Rivaroxaban for the prevention of venous
thromboembolism after total hip or total
knee replacement in adults (April 2009)
Rivaroxaban is
an option for
the prophylaxis
of
venous thromboembolism in adults after
total
hip
replacement or total knee replacement surgery.
RIVAROXABAN
Indications
see notes above
Cautions
see notes above; also bleeding disorders;
concomitant use of drugs that increase risk of bleed-
ing;
severe hypertension;
active or recent gastro-
intestinal ulceration;
vascular retinopathy; anaes-
thesia with postoperative indwelling epidural catheter
(risk of paralysis—monitor neurological signs and
wait at least 18 hours after rivaroxaban dose before
removing catheter and do not give next dose until at
least 6 hours after catheter removal); recent surgery;
interactions:
Appendix 1 (rivaroxaban)
Contra-indications
active bleeding
148
2.8.2 Oral anticoagulants
BNF 61
2
Cardiovascular system