Clinical management plan for use by …

1 Pharmacy Haematology King s College Hospital. CMP template agreed [Date] / For review [Date] Clinical management plan (CMP) for Anticoagulation Patients for use by Supplementary Prescribers at King s College Hospital Date Patient Name Patient ID Patient Medication Sensitivities Independent Prescriber Dr Raj Patel Supplementary Prescriber/s Rosalind Perrott KH 1132 Conditions to be treated: anticoagulation in atrial fibrillation, carotid dissection, cardiac thrombus, cardiomyopathy, arterial thrombus/graft, prosthetic valve replacement/repair, venous thromboembolism, inherited thrombophilia and antiphospholipid syndrome. Indication 1 Coumarin anticoagulants Prevention and treatment of thrombotic events according to guidelines1,2 Adjust dose to maintain INR in therapeutic range Indication 2 Low molecular weight heparin Prevention and treatment of thrombotic events according to guidelines1,2 Perioperative management of anticoagulation3 Indication 3 Vitamin K (phytomenadione) Reversal of anticoagulation when INR >7 or in patients presenting with bleeding or a high bleeding risk Treatment plan .

2 Monitor as frequently as indicated to maintain INR in range (at least 8 weekly) Referral to Independent Prescriber Any patient presenting with severe bleeding-haematuria, black stools, excessive bruising or severe nose bleeds since last visit Patients in whom the risk of haemorrhage is greater than the risk of thrombosis or re-thrombosis Allergy to warfarin, enoxaparin or vitamin K Pregnancy or possible pregnancy Process for reporting ADRs: Document in medical notes, complete yellow cards if appropriate, notify IP. Documentation and Record Keeping: Copy of Clinical management plan to be filed in anticoagulation office and in medical notes. All patient visits to be recorded on the DAWN computer database. Copies of all letters to GP and patient. SP Name/s & Signature/s Rosalind Perrott IP Name & Signature Dr Raj Patel Date Signed: Date agreed with patient Date for IP review of patient and CMP References 1.

3 Guidelines on oral anticoagulation (warfarin): third edition 2005 P. Baglin D. M. Keeling H. G. Watson for the British Committee for Standards in Haematology 2. The Pharmacology and management of the vitamin K antagonists. The seventh ACCP conference on antithrombotic and thrombolytic therapy. Jack Ansell, Jack Hirsh, Leon Poller, Henry Bussey, Alan Jacobson and Elain Hylek. CHEST/126/3/Sept 2004 supplement. 3. management of oral anticoagulation during invasive procedures. King s College Hospital. Nov 2004.