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 (Efient): increased risk of bleeding-  advice on timing of 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 myocardial infarction, October 2002

 TA47: Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes, September 2002 (updated March 2010)

  NG128: Stroke and transient ischaemic attack in over 16s: diagnosis and initial management, May 2019 (updated April 2022)

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.

Cangrelor is for use by specialists at EKUFT only, not at MTW.

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 acute ischaemic stroke patients only at present.

Streptokinase should be used as a temporary alternative for other indications , as agreed with haematology & cardiology.

See here for MTW 'Management of Pulmonary Embolism with Thrombolysis During Global Shortage of Alteplase' guidance.

Pack Price
56 tablet (4 x 14 tablets) £54.60
Pack Price
56 tablet £54.60
Pack Price
28 tablet £35.44
Pack Price
28 tablet £5.79
30 tablet

For use by specialists at EKUFT only, not at MTW.

Cangrelor should be considered as a second line therapy. Its role in treatment is limited to those patients who have not received an oral P2Y12 inhibitor (e.g. clopidogrel, prasugrel, ticagrelor) prior to a PCI procedure.

Cangrelor co-administered with aspirin, should be considered as a preferred treatment option for whom oral therapy with P2Y12 inhibitors is not feasible or desirable to replace use of crushed P2Y12 inhibitors given via an NG tube, or to replace use of injectable glycoprotein IIb/IIIa inhibitors (GPI) in this patient group.

Pack Price
10 vial £2,500.00