MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Antithrombotic Drugs

Drug Safety Update

  January 2014: Prasugrel increased risk of bleeding advice on loading dose

NICE Guidance (also see drug-specific links below)

 TA52: Guidance on the use of drugs for early thrombolysis in the treatment of acute MI, Oct 2002

 TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of ACS, updated March 2010

  NG128: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management, May 2019

Aspirin and clopidogrel are also used in the management of patients with acute coronary syndromes. See NICE guidance and section Antiplatelet drugs.

See here for local MTW thrombolysis guidance. However, please see below for supply issue and alternatives to alteplase for PE/MI patients.

Alteplase is also approved for intrapleural use at MTW by a respiratory consultant for the management of pleural infection in adults (unlicensed indication and route) only when surgery/transfer to tertiary care is not an option. It is to be requested from pharmacy on an individual patient basis only for this indication.

Tenecteplase is approved as an option for the treatment of acute, ischaemic stroke falling within the window for thrombolytic treatment. It is hospital only for specialist prescribing.

National Patient Safety Alert

Shortage of alteplase and tenecteplase injections

Please note there is currently a long-term shortage of alteplase and tenecteplase - see above alert for more information.

Limited supplies of alteplase are available - but this must be used for stroke patients only at present.

Temporary alternatives agreed with haematology & cardiology for other indications are as follows:

  • Urokinase for PE
  • Streptokinase for MI