REMEDY : BNSSG referral pathways & Joint Formulary

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BNSSG Paediatric Joint Formulary

2.3 Blood clots

Last edited: 31-01-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

2.3.1 Blocked catheters and lines

Secondary Care to maintain responsibility for monitoring amber specialist initiated drugs in the cardiovascular section of the Paediatric formulary. A clear management plan detailed in the clinic letter is required to support primary care prescribing. GP Practices should ensure a plan is in place before taking over prescribing responsibility

Prostaglandins (Cardiovascular)

Epoprostenol (TLS Red)

  • For pulmonary hypertension
  • Only on discussion with GOSH
  • BRCH guideline


2.3.2 Thromboembolism

Aspirin (TLS Amber specialist initiated) 

  • Secondary care are expected to stabilise the patient for the first month

Clopidogrel (TLS Red)



Danaparoid (TLS Red)

  • Restricted to heparin induced thrombocytopenia (HITS) and extra-corporeal circuit anticoagulation (dialysis) in patients who have had HITS



Enoxaparin (TLS Red)

Tinzaparin (TLS Red)

Heparin sodium (TLS Red)

Protamine (TLS Red)


Tissue Plasminogen Activator

Urokinase (TLS Red)

Taurolock (TLS Red)

Alteplase (TLS Red)

Streptokinase (TLS Red)


Vitamin K Antagonists

Warfarin (TLS Amber specialist initiated)

  • Use according to Trust guideline
  • If any new medication is initiated in a patient already taking warfarin please consider any potential drug interactions, and inform relevant warfarin clinic if appropriate as closer monitoring of INR may be required