Anticoagulants
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What you will learn
This module promotes the safe management of anticoagulants, a commonly used high risk medicine.
Learning outcomes
After completing this module, you should be able to:
- define anticoagulants and why they are high risk medicines
- recognise differences between types of anticoagulants and why they are used
- describe the signs and symptoms of bleeding
- discuss types of errors in the prescribing, dispensing and administration of anticoagulants and the common contributing factors
- identify safety strategies and governance structures to minimise the risk of errors associated with anticoagulants
- describe resources and tools available to help in the safe management of anticoagulants
- describe strategies to assist consumers to safely manage anticoagulants.
About this module
Relevance
This module is intended for all health care staff involved in the management of anticoagulants particularly in hospital, aged care and home care settings.
Duration
The module is designed to take around an hour to complete.
Certificate
On successful completion of the assessments you can download a certificate of completion.
Compliance
This module aligns with the National Safety and Quality Health Service Standards, Second Edition – Standards 1, 2, 4 & 6.
Disclaimer
This module content was developed by the Australian Commission on Safety and Quality in Health Care and is protected by copyright under a Creative Commons Attribution-Non-Commercial-Share Alike (BY-NC-ND) 4.0 International License.
The content is provided in good faith by the Commission for information purposes. It is not a substitute for, and is not intended to replace, any specific policies, guidelines or requirements for your local health network or health service.
The Commission does not accept any legal liability or responsibility for any injury, loss or damage incurred by the use of, or reliance on, this information.
Course release dates
| Date | |
|---|---|
| June 2025 | Rewritten to include new case studies and reflect changes to current practice, policies and standards. |
| October 2015 | First released. |
Resources
General resources
- High Risk Medicines. Australian Commission on Safety and Quality in Health Care (ACSQHC).
- APINCHS classification of high risk medicines. ACSQHC.
- Australian Medicines Handbook.
- Parenteral anticoagulants – Parenteral anticoagulants table. Australian Medicines Handbook.
- Oral anticoagulants – Oral anticoagulants table. Australian Medicines Handbook.
- Therapeutic Guidelines.
- Australian and New Zealand Living Clinical Guidelines for Stroke Management.
- Doost A, Alasady M, Scott P. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ. 2019 May;28(5):e106-e107. doi: 10.1016/j.hlc.2018.11.016.
- Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan CW, Chunilal SD, Ward CM, Baker R, Nandurkar H. New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism. Med J Aust. 2019 Mar;210(5):227-235. doi: 10.5694/mja2.50004.
- Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025.
Managing the effects of anticoagulants
- VTE Prevention Resources for staff and patients. Clinical Excellence Commission (CEC), NSW Health.
- BloodSafe eLearning Australia.
- High Risk Medicines resources. ACSQHC 2024.
- High Risk Medicine Standard - Anticoagulants. Clinical Excellence Commission (CEC), NSW Health, 2024.
- ISMP High-Alert Medications Lists. Institute for Safe Medication Practices 2024.
VTE Risk Assessment
- National Inpatient Medication Charts. NIMC.
- VTE Prevention Program. CEC NSW Health.
- VTE Prevention Clinical Care Standard 2020. ACSQHC.
- NIMC User Guide 2019. ACSQHC.
- Victorian Guideline for the prevention of venous thromboembolism (VTE) in adult hospitalised patients. Safer Care Victoria 2023.
- Victorian Framework for clinical decision support tools for Anticoagulants, 2023. The Victorian Therapeutic Advisory Group, VicTAG.
Direct oral anticoagulants (DOACs)
- Direct Oral Anticoagulant (DOAC) Guidelines, October 2023, October 2023. Clinical Excellence Commission, NSW Health.
- Anticoagulant Guideline for Hospitalised Adult Patients, February 2022. Queensland Health.
- Quick Reference Guide – Anticoagulants for Hospitalised Adult Patients (Dosing), June 2024. Queensland Health.
- Procedure: Anticoagulation Therapeutic Management (Adults only), June 2022 Canberra Health Services, ACT.
- Recommendations for Terminology, Abbreviations and Symbols. ACSQHC.
Unfractionated heparin (UFH)
Warfarin
- National Inpatient Medication Charts. NIMC.
- National Mixed-Case Lettering List. Australian Commission on Safety and Quality in Health Care.
- NPS MedicineWise information on warfarin. NPS MedicineWise.
- Individual hospitals may have their own Warfarin information booklets; contact your local pharmacy department or medicines information centre to find out more.
- Living with Warfarin. Information for patients. Government of Western Australia. Department of Health.
Systems approach
- Getting it Right: Guiding Principles for Medicines Stewardship Programs, Version 1, December 2022. CATAG; 2022. Council of Australian Therapeutic Advisory Groups (CATAG).
- Advancing Anticoagulation Stewardship: A Playbook. Washington, DC: NQF; 2022. National Quality Forum (NQF).
References
Why are anticoagulants high risk?
Clinical Excellence Commission (CEC), NSW Health. Patient Safety Watch Medication Safety: Edition 1/2024. Harm caused by omitting anticoagulants, October 2024. Sydney: CEC; 2024.
Dreijer AR, Diepstraten J, Bukkems VE, et al. Anticoagulant medication errors in hospitals and primary care: a cross-sectional study. Int J Qual Health Care. 2019 Jun 1;31(5):346-352.
Fanikos J, Tawfik Y, Almheiri D, et al. Anticoagulation-Associated Adverse Drug Events in Hospitalized Patients Across Two Time Periods. Am J Med. 2023 Sep;136(9):927-936.e3.
National Anticoagulant Incident Analysis. Sydney: ACSQHC; 2021.
Managing the effects of anticoagulants
Australian Medicines Handbook 2025. Anticoagulants. Australian Medicines Handbook Pty Ltd.
Bergmark BA, Kamphuisen PW, Wiviott SD, et al. Comparison of Events Across Bleeding Scales in the ENGAGE AF-TIMI 48 Trial. Circulation. 2019 Nov 26;140(22):1792-1801.
National Health Service. Side effects: Anticoagulant medicines, 09 September 2024 [internet]. NHS; 2024. https://www.nhs.uk/conditions/anticoagulants/side-effects/ (accessed 2024, Dec 10).
NPS MedicineWise. Oral anticoagulants: Safety checks, 05 March 2021 [internet]. NPS MedicineWise; 2022. https://www.nps.org.au/professionals/anticoagulants/oral-anticoagulants-safety-checks (accessed 2024, Dec 10).
Royal College of Pathologists of Australia (RCPA). Anticoagulant Monitoring, updated 2 Jan 2024 [internet]. RCPA; 2024. https://www.rcpa.edu.au/Manuals/RCPA-Manual/Clinical-Presentations-and-Diagnoses/A/Anticoagulant-monitoring (accessed 2024, Dec 10).
State of Queensland (Queensland Health). Anticoagulant Guideline for Hospitalised Adult Patients, February 2022. Queensland Health; 2023.
DOACs
Andexanet alfa for reversal of direct factor Xa inhibitor anticoagulation. Aust Prescr 2024;47:31-2.
Giannini J, Wong M, Dager W, et al. Direct Oral Anticoagulants are High Risk Medications with Potentially Complex Dosing. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services; 2020, June. https://psnet.ahrq.gov/web-mm/direct-oral-anticoagulants-are-High Risk-medications-potentially-complex-dosing (accessed 2024, Dec 10).
Rowily AA, Jalal Z, Paudyal V. Contributory factors and patient harm including deaths associated Direct Oral Anticoagulants (DOACs) medication incidents: evaluation of real world data reported to the National Reporting and Learning System. Expert Opin Drug Saf. 2023 Jul-Dec;22(11):1113-1125.
UFH
Eikelboom JW, Hankey GJ. Low molecular weight heparins and heparinoids. MJA 2002;177:379–83.
Institute for Safe Medication Practices (ISMP). 2024 ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations. ISMP; 2024.
Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood. 2005 Oct 15;106(8):2710-5.
State of Queensland (Queensland Health). Anticoagulant Guideline for Hospitalised Adult Patients, February 2022. Queensland Health; 2023.
Warfarin
Institute for Safe Medication Practices Canda (ISMP Canada). Alert: Beware of Potential Confusion between Pradax and Plavix, May 27 2011 [internet]. ISMP Canada; 2011, May. https://safemedicationuse.ca/alerts/downloads/ISMPC_alert_2011_05.pdf (accessed 2024, Dec 10).
Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024 Jan 2;149(1):e1-e156.
NHFA CSANZ Atrial Fibrillation Guideline Working Group. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ. 2018 Oct;27(10):1209-1266.
NSW Health. Policy Directive: Medication Handling PD2022_032, 11 August 2022. NSW Health; 2022.
State of Queensland (Queensland Health). Guideline for Warfarin Management in the Community, February 2024. Queensland Health; 2024.
Tideman PA, Tirimacco R, John AS, et al. How to manage warfarin therapy. Aust Prescr 2015;38:44-8.
Victorian Therapeutic Advisory Group (VicTAG): Quality Use of Medicine Group. High Risk Medicine Alert: Warfarin, February 2023. VicTAG; 2023.
Low-molecular-weight-heparin (LMWH)
Eikelboom J, Hankey G. Low Molecular Weight Heparins and heparinoids. Med J Australia. 2002;177:379–83.
Lowinger J, Maxwell D. Heparins for venous thromboembolism prophylaxis – safety issues. Australian Prescriber. 2009;32(4):108–12.
System approach
Austin J, Barras M, Sullivan C. Interventions designed to improve the safety and quality of therapeutic anticoagulation in an inpatient electronic medical record. Int J Med Inform. 2020 Mar;135:104066.
Institute for Safe Medication Practices. Use of 'NoAC' abbreviation. ISMP Medication Safety Alert! Acute Care, Volume 18, Issue 25, December 12, 2013.
Irish Medication Safety Network (IMSN). Safety Alert: Direct Oral Anticoagulants (DOACs), January 2018. IMSN; 2018.
Rowily AA, Jalal Z, Paudyal V. Contributory factors and patient harm including deaths associated direct acting oral anticoagulants (DOACs) medication incidents: evaluation of real world data reported to the National Reporting and Learning System. Expert Opin Drug Saf. 2023 Jul-Dec;22(11):1113-1125.
Institute for Safe Medication Practices (ISMP). 2017 ISMP Medication Safety Self Assessment® for Antithrombotic Therapy. ISMP; 2017.
Thornton P. Medication Safety (Australian Incidents: Novel Oral Anticoagulants/Direct Oral Anticoagulants (NOAC/DOAC) Incidents, International Incidents: Safety Contrasts for New Newer Anticoagulants). J Pharm Pract Res. 2016, 46: 156-168.
Victorian Therapeutic Advisory Group (VicTAG). Victorian Framework for clinical decision support tools for Anticoagulants, April 2023. VicTAG; 2023.
