Anticoagulant Treatment

Oral anticoagulants in New Zealand

Warfarin and dabigatran (Pradaxa) are the commonly used oral anticoagulants. Rivaroxaban is available for prophylaxis following orthopaedic procedures on special authority and Apixaban is available but not funded.

Low Molecular Weight Heparin

Enoxaparin (Clexane) and Dalteparin (Fragmin) are available in New Zealand.

• Treatment is given subcutaneously
• Treatment is given once (1.5mg/kg) or twice a day (1mg/kg bd).
• The dose is reduced if renal function is reduced (1mg/kg daily).

Treatment for atrial fibrillation

Patients with newly diagnosed arial fibrillation can be started on either dabigatran or warfarin. They do not require an initial course of LMW heparin unless they have had a recent stroke.

Dabigatran

The standard dose is 150mg bd. A reduced dose of 110mg bd can be used in the elderly or those with marginally impaired renal function. Dabigatran is not recommended in severe renal failure (GFR <30ml/min) and should be used with caution in those with a history of GI bleeding. Regular monitoring is not required.

A smart phone App is available to help with Dabigatran management