Roche CoaguChek XS Plus, Training Manual

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CoaguChek Professional Monitoring Systems
Training Manual
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11
Clinic procedure for novel anticoagulants
There are currently NICE technology appraisals available for stroke prevention in atrial fibrillation for
dabigatran, rivaroxaban, and apixaban
Technology appraisals suggest that they should be made available for patients who require them but
that the decision on choice of agent should be undertaken only following an informed discussion with
the individual patient.
In addition, rivaroxaban and dabigatran are licensed for the treatment and secondary prevention of
venous thromboembolism.
Dabigatran
is a direct thrombin inhibitor which works by inhibiting the action of thrombin, and so
prevent the conversion of fibrinogen to fibrin. The advantages of thrombin inhibitors are that their
pharmacokinetics are predictable and they can be taken orally without regular monitoring of a patient’s
INR and the activated partial thrombin time (APTT).
It is licensed in the UK for for non-valvular atrial fibrillation, treatment and secondary prevention of
venous trhromboembolism and for prophylaxis for knee and hip replacements.
For stroke prevention in atrial fibrillation, patients who would be considered for warfarin should be
considered for dabigatran.
Dose
Daily dose of Dabigatran of 300 mg, taken as one 150 mg capsule twice daily for patients with AF
This dose should be reduced for patients aged 80 years or older to a daily dose of 220 mg, taken as
one 110 mg capsule twice daily, because of the increased risk of bleeding in this population.
For patients aged 75–80 years, consider a dose of 220 mg taken as one 110 mg capsule twice daily
for individual patients whose thromboembolic risk is low and bleeding risk is high.
Starting Dabigatran
It has a half life 12 -17 hours and the onset of effect starts shortly after dosing , maximum
anticoagulant effect achieved within 0.5 – 2 hours.
There is no need to give LMWH for atrial fibrillation
Rivaroxaban
is a factor Xa inhibitors which works by inhibiting factor Xa, but allows residual
thrombin to carry out its other important functions.
Rivaroxaban is licensed for non-valvular atrial fibrillation, treatment and secondary prevetnuon of
venous trhromboembolism and for prophylaxis for knee and hip replacements.