Anticoagulant medicines are used extensively in clinical practice. They have a narrow therapeutic index and over or under anticoagulation can result in significant adverse patient outcomes.

Anticoagulant incidents

Incidents involving anticoagulant medicines can include:

  • Duplication of therapy. For example, ordering pharmacological venous thromboembolism (VTE) prophylaxis for patients who are receiving therapeutic anticoagulation
  • Use of a therapeutic dose when a prophylactic dose was intended and vice versa
  • Failure to adjust an anticoagulant dose according to patient factors. For example, haematology parameters, biochemistry, estimated creatinine clearance, age
  • Incorrect protocol use. For example, administration of a concentration of unfractionated heparin solution contrary to the protocol resulting in administration of an incorrect dose
  • Incorrect use following discharge. For example, inadequate patient and/ or carer education for patients being discharged on anticoagulants resulting in adverse events.

Anticoagulants Standard

The Anticoagulants Standard of the NSW Health High-Risk Medicines Management Policy (PD2020_045) outlines the minimum actions required to reduce risks associated with anticoagulant use. The Standard includes a risk mitigation strategy, and also addresses anticoagulant prescribing, storage, supply, administration, patient monitoring, pharmaceutical review and patient information and education requirements.

To assist hospitals in monitoring risks associated with anticoagulant use, the tool below can be used to monitor local implementation and compliance with the Anticoagulant Standard of the High-Risk Medicines Management Policy.

Intravenous Unfractionated Heparin Recommended Standard

An Intravenous Unfractionated Heparin Recommended Standard has been developed to assist in the standardisation of intravenous unfractionated heparin management in NSW Public Health facilities. It is not intended that clinicians use this Recommended Standard to guide therapy, rather the contents of the Recommended Standard should be included in local intravenous unfractionated heparin protocols. A local nomogram must be developed according to the local laboratory reference range.


Non-Vitamin K antagonist oral anticoagulants (NOAC) are now widely used in patients with non-valvular atrial fibrillation (AF) and for the treatment and prevention of venous thromboembolism (VTE) in NSW Health facilities. NOACs include dabigatran, (direct thrombin inhibitor), apixaban and rivaroxaban (Factor Xa inhibitors). The term 'DOAC', (Direct Oral Anticoagulant) is also used to describe these medicines.

The CEC NOAC Guidelines and associated documents are intended to assist clinicians with the inpatient and discharge management of patients receiving a NOAC. The NOAC Guidelines and associated documents should be printed in colour.

Perioperative Management of Anticoagulant and Antiplatelet Agents

Guidelines on Perioperative Management of Anticoagulant and Antiplatelet Agents have been developed to assist clinicians with the inpatient and outpatient management of adult patients undergoing procedures who are taking anticoagulant or antiplatelet therapy. In addition, communication documents have been developed to assist with communicating the anticoagulant plan with patients and other health care professionals.