Pulmonary embolism
Separate formulary recommendations are available for reversal agents in cardiovascular conditions.
Refer to local treatment guidelines.
Direct Acting Oral Anticoagulants (DOACs) – consult local guidelines for preferred 1st line choice. Ensure loading doses and durations are completed before maintenance dosing commences.
If a DOAC is unsuitable consider LMWH alone or LMWH concurrently with a VKA for at least 5 days, or until the INR is at least 2.0 in 2 consecutive readings, followed by a VKA on its own. Consult local guidelines for preferred LMWH.
For use in heparin infusions where immediate anticoagulant effect is needed or reversibility is required.
When patients have heparin-induced thrombocytopenia type II requiring parenteral antithrombotic treatment. Refer to local guidelines.
Prescribing Notes:
- See SIGN 129 Antithrombotics: indications and management.
- When warfarin or DOAC therapy is initiated, anti-platelet therapy is normally discontinued, except on specialist advice by cardiology or vascular specialities to continue. This will be communicated in individual patient correspondence.
- See separate pathway for reversal agents for cardiovascular medications.
History Notes
27/05/2026
Regional formulary chapter launched.
Prescribing Notes:
- See local guidelines for further information.
- Thrombolytic treatments must be used in strict accordance with detailed protocols.
- Different preparations of alteplase have different licensed indications and doses.
History Notes
27/05/2026
Regional formulary chapter launched.