WA Anticoagulation Medication Chart

OD 0522/14 Revision of Adult WA Anticoagulation Medication Chart (WA AMC) - Operational Directive (external site)

The WA Anticoagulation Medication Chart (WA AMC) has been available for use in WA hospitals since mid-2007. The aim of the WA AMC is to improve both dosing and monitoring of anticoagulants and subsequently reduce the risk of anticoagulant-related patient harm.

Available at point of care, the WA AMC provides:

  • decision support on appropriate indications
  • optimal dosing regimens
  • monitoring requirements
  • reversal guidelines of anticoagulant therapy

Additionally, there are prompts for patient education and provision of information to the patient’s general practitioner – to facilitate continuity of care after the patient is discharged from hospital.

A revision of the chart occurred in 2012, and several changes were made to the chart to reflect safety issues. The changes to the chart include:

  • Separate regular dose order prescription areas for VTE prophylaxis and treatment doses. This highlights the different dosing requirements. This section of the chart is also designed for patients who have changes in their therapy. This reduces the need for multiple anticoagulant charts for the patient.  For example:
    • Changing from subcutaneous heparin prior to surgery to enoxaparin post-surgery for VTE prophylaxis
    • Changing from VTE prophylaxis doses to treatment doses of heparin (and vice versa)
  • Information on fixed dose novel oral anticoagulants (NOACs – i.e. dabigatran, rivaroxaban, apixaban) that should be prescribed on this chart. Doses should be prescribed in the relevant sections depending on indication – i.e. prophylaxis or treatment. These agents do not currently have a specific reversal agent. Care should be taken when prescribing these agents in the elderly (>75 years), underweight patients (< 50kg) and patients with renal impairment (creatinine clearance <30mL/min).
  • Inclusion of more cautionary recommendations with regards to withholding low molecular weight heparin (LWMH) prior to procedures and surgical interventions, especially in patients at high risk of bleeding.
  • Clearer instructions for warfarin reversal guidelines in response to high INR and bleeding risk.
  • Clarification of rows indicating approximate patient weight on the intravenous heparin nomograms.

Resources for health professionals

Resources for patients

More information

Quality Improvement and Change Management Unit
Address: 189 Royal Street, East Perth
Phone: 9222 4080
Email: qicm@health.wa.gov.au

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Quality Improvement and Change Management Unit