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.

3 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. 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.

4 King s College Hospital. Nov 2004.