A+Acute Medical TakeUK Acute Medicine Clinical Guide

Clinical evidenceNICE · Specialist guidance · UpToDate

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New to the NHS⌄

New to the NHSChoose a topic

Open the complete fourteen-stage guide→Stage 1 — Before you start→Stage 2 — Your first shift→Stage 3 — Your first month→Stage 4 — Building your NHS career→Stage 5 — Working on the Acute Medical Take→Stage 6 — Prescribing safely→Stage 7 — Documentation & communication→Stage 8 — Consent, capacity & confidentiality→Stage 9 — Escalation & patient safety→Stage 10 — DNACPR, treatment ceilings & end-of-life care→Stage 11 — Common NHS referrals→Stage 12 — Practical procedures & investigations→Stage 13 — Working patterns & wellbeing→Stage 14 — Training & career development→

Investigations⌄

InvestigationsChoose a topic

Abdominal paracentesis procedure→ABG sampling procedure→Biochemistry→Blood-culture collection→Cardiac→Chest-drain insertion→Endocrine→Haematology→Imaging interpretation→Lumbar puncture procedure→Microbiology→Neurological & CSF→Open investigations hub→Point of care & blood gases→Search all investigations→Urine & urology→Venepuncture procedure→

Calculators⌄

CalculatorsChoose a topic

Acute & emergency — NEWS2, GCS, qSOFA→All clinical calculators→Cardiology — HEART, CHA₂DS₂-VASc, HAS-BLED→Critical care — SOFA, APACHE, anion gap→Endocrinology — corrected calcium, osmolality→Gastroenterology — GBS, Rockall, Child-Pugh→Geriatrics — frailty, delirium, falls→Haematology & oncology — ANC, VTE risk→Infection — qSOFA, SIRS, Centor→Neurology — NIHSS, ABCD², ICH score→Obstetric medicine — pregnancy risk tools→Psychiatry — withdrawal and risk scores→Renal — eGFR, CrCl, FENa→Respiratory — CURB-65, Wells PE, PESI→Rheumatology — disease activity scores→Starting a DOAC — dose & safety checks→

Cardiology⌄

CardiologyChoose a topic

Acute aortic syndromes→Acute heart failure→Adult congenital heart disease→Antiplatelet & anticoagulant management→Atrial fibrillation→Cardiac disease in pregnancy→Cardiac masses & intracardiac thrombus→Cardiac rehabilitation after ACS/PCI/CABG→Cardiac trauma→Cardio-oncology→Cardiogenic shock→Cardiovascular disease in CKD→Chest pain and ACS→Chronic heart failure / CCF→Conduction disorders→Dyslipidaemia & secondary prevention→ECG interpretation→Hypertensive emergencies→Infective endocarditis→Inherited conditions & channelopathies→Myocarditis→Pericardial effusion & tamponade→Pericarditis→Peripheral arterial & systemic atherosclerosis→Post-PCI & post-CABG complications→Pre-operative cardiac risk→Prosthetic-valve emergencies→Pulmonary hypertension & right-heart failure→Valvular heart disease→

ECG Atlas⌄

ECG AtlasChoose a topic

01 · Normal sinus rhythm→02 · Atrial flutter / atrial arrhythmias→03 · Ventricular tachycardia→04 · Ventricular fibrillation→05 · Complete heart block→06 · Long QT and torsades→07 · Pulmonary embolism / RV strain→08 · Type-1 Brugada pattern→09 · Pacemaker ECG→10 · Lead reversal→11 · Anterior STEMI→12 · Acute pericarditis→13 · Left bundle branch block→14 · Left ventricular hypertrophy with strain→15 · Severe hyperkalaemia→16 · Severe hypokalaemia→17 · Assessing telemetry→18 · Atrial fibrillation→19 · Atrial flutter→20 · Regular narrow-complex SVT→21 · First-degree AV block→22 · Mobitz I AV block→23 · Mobitz II / high-grade AV block→24 · Right bundle branch block→25 · WPW pre-excitation→26 · Inferior STEMI→27 · Right-ventricular STEMI→28 · Hypocalcaemia ECG→29 · Cardiac glycoside toxicity→ECG in acute coronary syndrome→ECG in hyperkalaemia→Open ECG Atlas→Systematic ECG interpretation→

Imaging Atlas⌄

Imaging AtlasChoose a topic

Acute neuro-imaging pathways→Critical imaging findings→CT scans→Indications for echocardiography→MRI→Open Imaging Atlas→Special imaging→X-rays→

Emergency Algorithms⌄

Emergency AlgorithmsChoose a topic

Acute hyperkalaemia→Acute severe asthma→Acute upper-airway obstruction→Anaphylaxis→Cardiac Arrest Algorithm (typed PDF)→Emergency escalation and critical-care referral→Major haemorrhage→Opioid toxicity and respiratory depression→Peri-arrest bradycardia→Peri-arrest tachycardia→Reduced consciousness→Respiratory arrest→Sepsis Six and shock→Severe hypoglycaemia→Status epilepticus→

Endocrinology⌄

EndocrinologyChoose a topic

Acromegaly & pituitary tumours→Acute hypocalcaemia→Adrenal incidentaloma & malignancy→Adrenal insufficiency & adrenal crisis→All endocrinology pathways→AVP deficiency / diabetes insipidus→Cancer immunotherapy endocrinopathy→Cushing syndrome & cortisol excess→Diabetes fasting, surgery & feeding→DKA and HHS→Endocrine disease in pregnancy→Endocrine investigations→Euglycaemic DKA / SGLT2→Hypoglycaemia→Inpatient diabetes & insulin→Insulin pumps & CGM→Male hypogonadism & testosterone→MEN & inherited syndromes→Obesity & central adiposity→Osteomalacia & metabolic bone→Osteoporosis & fragility fractures→PCOS & reproductive endocrinology→Phaeochromocytoma crisis→Pituitary apoplexy→Primary aldosteronism→Primary hyperparathyroidism→Severe hypercalcaemia→SIADH & endocrine hyponatraemia→Steroid sick-day & surgical cover→Thyroid emergencies→Vitamin deficiencies→

Renal⌄

RenalChoose a topic

Acid–base & blood gases→Acute glomerulonephritis & RPGN→Acute interstitial nephritis→Acute kidney injury→All renal & metabolic pathways→Cardiorenal syndrome & diuretic resistance→CKD & acute-on-chronic kidney injury→CKD anaemia, IV iron & ESA→CKD mineral & bone disorder→Conservative kidney management→Contrast-associated AKI→Diabetic kidney disease→Dialysis access & complications→Electrolyte imbalances→Emergency dialysis indications→Fluid assessment & IV fluids→Haematuria & proteinuria→Haemodialysis emergencies→Kidney biopsy→Monoclonal gammopathy & myeloma kidney→Nephrotic syndrome→Nephrotoxins, dosing & sick days→Nutrition in advanced CKD & dialysis→Obstructive uropathy→Onconephrology & treatment nephrotoxicity→Paediatric & adolescent renal emergencies→Peritoneal dialysis & peritonitis→Polycystic & inherited nephropathies→Pregnancy with kidney disease→Pulmonary–renal syndrome & vasculitis→Pyelonephritis, complicated UTI & abscess→Renal & urine investigations→Renal calculi & infected obstruction→Renal disease in systemic disorders→Renal vascular emergencies→Resistant hypertension & renovascular disease→Rhabdomyolysis & pigment AKI→Severe acidosis & RTA→Thrombotic microangiopathy→Transplant & immunosuppression emergencies→Urinary retention & post-obstructive diuresis→

Gastrointestinal⌄

GastrointestinalChoose a topic

Acute abdomen→Acute alcohol-associated hepatitis→Acute cholangitis & biliary sepsis→Acute cholecystitis→Acute diarrhoea→Acute gastric-outlet obstruction→Acute hepatitis & jaundice→Acute pancreatitis→Acute severe colitis→Alcohol withdrawal→Alcohol-withdrawal seizure→All gastrointestinal pathways→Ascites & spontaneous bacterial peritonitis→Autoimmune hepatitis→Bowel obstruction & ileus→C. difficile—initial, recurrent & fulminant→Caustic ingestion→Chronic diarrhoea→Chronic pancreatitis & exocrine insufficiency→Coeliac disease & malabsorption→Constipation & faecal impaction→Crohn disease & ulcerative colitis→Decompensated chronic liver disease→Diverticulitis→Dysphagia & food-bolus obstruction→Enteral & parenteral nutrition→Gastritis, oesophagitis & GORD→Gastroparesis & motility disorders→GI & hepatobiliary malignancy→GI & liver disease in pregnancy→GI polyps & hereditary cancer syndromes→Haemochromatosis & Wilson disease→Hepatic encephalopathy→Hepatitis A→Hepatitis B→Hepatitis C→Hepatitis D→Hepatitis E→Hepatorenal syndrome→High-output stoma & intestinal failure→IBS & functional GI disorders→Liver biopsy→Liver investigations & NILS→Liver masses & HCC→Liver-transplant emergencies→Lower GI bleeding→MASLD→Mesenteric ischaemia→Microscopic colitis & bile-acid diarrhoea→Neutropenic enterocolitis→Oesophageal rupture & perforation→Pancreatic necrosis & pseudocyst→PBC & PSC→PEG, feeding-tube & stoma complications→Peptic ulcer disease→Persistent nausea & vomiting→Portal hypertension & variceal prevention→Portal-vein thrombosis & Budd–Chiari→Post-endoscopy & ERCP complications→Supportive & palliative GI/liver care→Upper GI bleeding→

Infection⌄

InfectionChoose a topic

High priority

Acute cholangitis and cholecystitis→Antimicrobial resistance and safe empirical prescribing→Antiretroviral medicines→Atypical pneumonia→Bite wounds, zoonoses and post-exposure prevention→Candidemia and invasive fungal infection→Cellulitis, erysipelas and necrotising soft-tissue infection→Central-line and device-associated infection→

Specialist topics

Clostridioides difficile infection and toxic megacolon→CMV, HSV and VZV infection→Cryptococcosis and cryptococcal meningitis→Emerging diseases→Extrapulmonary tuberculosis→Fever in the returning traveller→Fever with rash and high-consequence infection→HIV→Infections during pregnancy and postpartum→Infective endocarditis→Influenza, COVID-19 and severe respiratory viral infection→Intra-abdominal infection and peritonitis→Invasive aspergillosis and mucormycosis→Meningitis & encephalitis→Non-tuberculous mycobacterial infection→Occupational and sexual exposure prophylaxis→Outpatient parenteral antimicrobial therapy (OPAT)→Pneumocystis pneumonia (PCP/PJP)→Pneumonia→Prosthetic-joint, vascular-graft and cardiac-device infection→Pulmonary tuberculosis→Pyelonephritis, complicated UTI and urosepsis→Septic arthritis and osteomyelitis→Sexually transmitted infections→Strongyloidiasis and hyperinfection→Suspected sepsis→The immunocompromised patient→Toxoplasmosis and opportunistic CNS infection→Travel medicine→Tropical diseases→Typical bacterial pneumonia→

Toxicology⌄

ToxicologyChoose a topic

High priority

All toxicology pathways→Antipsychotic poisoning and neuroleptic malignant syndrome→Benzodiazepine and sedative poisoning→Beta-blocker overdose→Calcium-channel blocker overdose→Cannabis toxicity & hyperemesis→Carbon monoxide and cyanide poisoning→Cocaine toxicity→

Specialist topics

Digoxin and cardiac-glycoside poisoning→Drug-induced hyperthermia and severe agitation→Gabapentin overdose→Iron poisoning→Lithium poisoning→Opioid and fentanyl toxicity→Organophosphate and cholinergic poisoning→Paracetamol overdose→Salicylate poisoning→Serotonin toxicity and serotonergic overdose→Toxic alcohol poisoning—methanol and ethylene glycol→Tricyclic antidepressant poisoning→

Oncology⌄

OncologyChoose a topic

High priority

All oncological emergencies→Bone metastases & skeletal-related events→Brain metastases & raised intracranial pressure→Cancer of unknown primary→Cancer pain crisis & opioid toxicity→Cancer-associated thrombosis→CAR-T/bispecific CRS & ICANS→Chemotherapy extravasation→DIC & cancer-associated bleeding→Haematological malignancies→Haemophagocytic lymphohistiocytosis→Immunotherapy-related toxicity→

Specialist topics

Leukostasis & hyperviscosity→Malignancy-related hypercalcaemia→Malignant airway obstruction & stridor→Malignant ascites→Malignant bowel obstruction, perforation & fistula→Malignant pericardial effusion & tamponade→Malignant pleural effusion→Malignant urinary obstruction & nephrostomy→Metastatic spinal cord compression→Neutropenic enterocolitis & severe diarrhoea→Neutropenic sepsis→Obstructive jaundice & malignant cholangitis→Oncological emergencies during pregnancy→Paraneoplastic endocrine & metabolic syndromes→Pathological & impending fractures→Radiotherapy complications→Rapid palliative symptom control→Stem-cell transplant complications & GVHD→Superior vena cava obstruction→Systemic anticancer therapy toxicity→Targeted-therapy toxicities→Tumour lysis syndrome→

MRCP(UK)⌄

MRCP(UK)Choose a topic

Eligibility and attempts→Exam dates, fees and application→MRCP(UK) overview→Official MRCP(UK) resources→PACES clinical examination→Part 1→Part 2 Written→

Neurology⌄

NeurologyChoose a topic

High priority

Acute demyelination, MS, NMOSD & MOGAD→Acute headache→Acute weakness & paralysis→All neurological emergencies→Autoimmune encephalitis→Autonomic disorders & dysautonomia→Cerebral venous sinus thrombosis→Coma & acute encephalopathy→Dementia & rapidly progressive cognitive decline→Epilepsy & long-term antiseizure management→First seizure, clusters & non-convulsive status→Functional neurological disorder→

Specialist topics

Guillain–Barré syndrome & CIDP→Intracerebral haemorrhage & anticoagulant bleeding→Meningitis and encephalitis→Motor neurone disease→Movement disorders→MS & chronic demyelinating disease→Myasthenia gravis→Myopathy, myositis & muscular dystrophy→Neuro-oncology, leptomeningeal & paraneoplastic disease→Neuro-ophthalmological emergencies→Neurogenetic & mitochondrial disorders→Neurological disease in pregnancy→Neuromuscular respiratory failure→Neurorehabilitation, spasticity & neuropalliative care→Parkinson disease & atypical parkinsonism→Peripheral neuropathy & radiculopathy→Posterior-circulation stroke & acute vestibular syndrome→Raised ICP, cerebral oedema & herniation→Seizure and status epilepticus→Sleep neurology→Spinal cord and cauda equina compression→Stroke and TIA→Subarachnoid haemorrhage→Traumatic brain injury & concussion→Tremor, chorea, dystonia, myoclonus & ataxia→

Investigations & procedures

Acute neuroimaging—CT/CTA/CTP/MRI/MRA/MRV→Brainstem-death testing & neuroprognostication→Carotid, vertebral & intracranial vascular studies→Diagnostic lumbar-puncture procedure→EEG, video-EEG & continuous EEG→Fundoscopy & papilloedema→NCS, EMG & evoked potentials→Neurological investigations & CSF→NIHSS, GCS, ASPECTS & posterior assessment→Stroke thrombolysis & thrombectomy→

Professional Practice⌄

Professional PracticeChoose a topic

Datix and patient safety→DNACPR→Escalation→Rehabilitation→Role of the MDT→

Critical Care⌄

Critical CareChoose a topic

Critical-care referral, transfer and handover→Critical-care sedation, analgesia and delirium→Deteriorating patient, NEWS2 and rapid response→Difficult airway and emergency tracheal intubation→Invasive mechanical ventilation→Post-cardiac-arrest care and neuroprognostication→Renal replacement therapy in critical illness→Shock differentiation and vasoactive support→

Geriatrics⌄

GeriatricsChoose a topic

Acute frailty assessment and comprehensive geriatric assessment→Deconditioning, immobility and pressure-injury prevention→Delirium — enhanced pathway & 4AT→Dementia with acute behavioural or functional deterioration→Dysphagia, aspiration and nutrition in frailty→Falls, gait instability and multifactorial assessment→Fragility fracture, osteoporosis and bone protection→Parkinsonism, Lewy body dementia and medicine timing→Polypharmacy, deprescribing and adverse drug reactions→Safeguarding, self-neglect and discharge risk→Syncope and collapse in older adults→Urinary retention, incontinence and constipation→

Rheumatology⌄

RheumatologyChoose a topic

Acute monoarthritis, gout and CPPD→Adult-onset Still disease and cytokine storm→Giant-cell arteritis and polymyalgia rheumatica→Inflammatory arthritis flare and immunosuppressant complications→Inflammatory myositis and rhabdomyolysis differential→Scleroderma renal crisis→Systemic lupus erythematosus emergencies→Systemic vasculitis and pulmonary–renal syndrome→

Dermatological Emergencies⌄

Dermatological EmergenciesChoose a topic

Autoimmune blistering disease—pemphigoid and pemphigus→Cellulitis mimics and inflammatory red leg→DRESS syndrome and severe drug hypersensitivity→Eczema herpeticum and disseminated viral skin infection→Erythroderma→Severe psoriasis and generalised pustular psoriasis→Stevens–Johnson syndrome and toxic epidermal necrolysis→Vasculitic, purpuric and non-blanching rash→

Acute Ophthalmology⌄

Acute OphthalmologyChoose a topic

Acute angle-closure glaucoma→Chemical eye injury→Giant-cell arteritis with visual symptoms→Ocular trauma and open-globe injury→Optic neuritis and acute optic neuropathy→Orbital cellulitis and cavernous sinus complications→Painful red eye—uveitis, keratitis and scleritis→Sudden painless visual loss→

Allergy & Clinical Immunology⌄

Allergy & Clinical ImmunologyChoose a topic

Acute angioedema and airway risk→Biologic therapy reactions and immunogenicity→Hereditary and acquired bradykinin-mediated angioedema→Immunodeficiency with acute infection→Immunoglobulin infusion reactions→Mast-cell activation and recurrent idiopathic anaphylaxis→Severe drug hypersensitivity and immediate allergy→

Acute Psychiatry⌄

Acute PsychiatryChoose a topic

Acute mania→Acute psychosis and first-episode psychosis→Capacity, consent and Mental Health Act interface→Catatonia and malignant catatonia→Eating-disorder medical emergencies→Neuroleptic malignant syndrome and serotonin toxicity→Panic, severe anxiety and functional symptoms→Perinatal and postpartum psychiatric emergency→Self-harm and suicide-risk assessment→Severe agitation and behavioural disturbance→Severe depression with psychotic or stuporous features→Substance intoxication and withdrawal→

Musculoskeletal⌄

MusculoskeletalChoose a topic

Acute compartment syndrome→Acute hip pain and inability to weight-bear→Acute inflammatory polyarthritis→Acute limb neurovascular compromise→Acute monoarthritis and suspected septic joint→Acute neck pain and cervical spine emergency→Acute shoulder pain and loss of function→Acute spinal injury, back pain and spinal red flags→Crystal arthritis and inflammatory flare→Fragility fracture and acute osteoporosis care→Hand infection, bite and flexor tenosynovitis→Knee injury and acutely locked knee→Major fracture and joint dislocation→Muscle weakness and inflammatory myopathy→Musculoskeletal infection and necrotising soft-tissue infection→Pathological fracture and suspected bone or soft-tissue malignancy→Prosthetic-joint complications→Rhabdomyolysis and crush injury→Tendon rupture and acute soft-tissue injury→Vasculitis and connective-tissue disease emergency→

ENT Emergencies⌄

ENT EmergenciesChoose a topic

Acute epistaxis and major nasal haemorrhage→Acute vertigo and peripheral vestibular emergencies→Deep-neck space infection and peritonsillar abscess→ENT foreign body, facial trauma and post-tonsillectomy bleed→Sudden sensorineural hearing loss→Upper-airway obstruction, stridor and supraglottitis→

Palliative & Supportive Medicine⌄

Palliative & Supportive MedicineChoose a topic

Agitation, delirium and psychological distress at end of life→Breathlessness in advanced illness→Care in the last days of life and anticipatory prescribing→Nausea, vomiting, bowel obstruction and secretions→Palliative pain crisis and opioid safety→Rapid palliative assessment and goals of care→Syringe driver prescribing and troubleshooting→

Nutrition & Metabolic Support⌄

Nutrition & Metabolic SupportChoose a topic

Dysphagia, aspiration risk and texture-modified nutrition→Enteral tube feeding—selection, placement and complications→High-output stoma and short-bowel intestinal failure→Malnutrition screening and refeeding-risk pathway→Micronutrient deficiency and specialised supplementation→Parenteral nutrition and intestinal failure→

All Specialties A–Z⌄

All Specialties A–ZChoose a topic

All clinical pathways→Cardiology→Critical Care→Electrolyte Imbalances→Endocrinology→ENT Emergencies→Gastrointestinal→Geriatrics→Haematology→Infection→Neurology→Nutrition & Metabolic Support→Oncology→Palliative & Supportive Medicine→Renal→Respiratory→Rheumatology→Toxicology→

Respiratory⌄

RespiratoryChoose a topic

High priority

6-minute walk & exercise testing→ABG interpretation in respiratory failure→ABPA & pulmonary aspergillosis→Acute hypercapnic respiratory failure→Acute hypoxaemic failure & ARDS→Acute ILD exacerbation→Acute NIV and AIRVO→Acute severe asthma→Air travel & fitness to fly→Alpha-1 antitrypsin deficiency→Approach to Breathlessness→Aspiration pneumonia & pneumonitis→

Specialist topics

Bronchiectasis exacerbation→Bronchiectasis—long-term management→Chest X-ray & thoracic CT interpretation→Chronic cough→Community & hospital pneumonia→COPD exacerbation→Cystic fibrosis in adults→Deep-vein thrombosis (DVT)→Emergency oxygen prescribing→Eosinophilic lung disease & vasculitis→Foreign body & central-airway obstruction→Interstitial lung disease→Long-term oxygen & home NIV→Lung cancer & pulmonary nodules→Lung-cancer emergencies→Lung-transplant emergencies→Massive haemoptysis→Neuromuscular/chest-wall respiratory failure→Occupational & environmental lung disease→OSA & obesity-hypoventilation→Peak flow & bronchial challenge→Pleural effusion & empyema→Pleural-fluid interpretation→Pneumothorax & tension pneumothorax→Preoperative respiratory assessment→Pulmonary AVMs→Pulmonary embolism→Pulmonary hypertension & right-heart failure→Pulmonary rehabilitation→Respiratory disease in pregnancy→Sarcoidosis→Sleep studies→Smoking cessation→Spirometry & complete lung function→TB & non-tuberculous mycobacteria→Thoracic ultrasound→Tracheostomy & laryngectomy emergencies→

Investigations & procedures

Bronchoscopy→Chest drains→Pleural disease & procedures→

Haematology & Genetics⌄

Haematology & GeneticsChoose a topic

High priority

Acute haemolytic anaemia & AIHA→Acute lymphoblastic leukaemia (ALL)→Acute myeloid leukaemia (AML)→Acute transfusion reactions→AL amyloidosis→Anaemia→Anticoagulant bleeding & reversal→Anticoagulant reversal quick-reference→Asplenia, hyposplenism and post-splenectomy care→Blood-component selection and prescribing→Blood-film interpretation→Bone-marrow aspiration and trephine biopsy→

Specialist topics

Chronic lymphocytic leukaemia (CLL)→Chronic myeloid leukaemia (CML)→Coagulation-screen and mixing-study interpretation→Disseminated intravascular coagulation→Eosinophilia and hypereosinophilic syndromes→Erythrocytosis and secondary polycythaemia→Evans syndrome→G6PD deficiency and hereditary red-cell disorders→Haematological disorders during pregnancy→Haemophagocytic lymphohistiocytosis—haematology route→Haemophilia, VWD & acquired inhibitors→Heparin-induced thrombocytopenia→Hypochromic microcytic anaemia→Iron overload, haemochromatosis and chelation→Lymphoma→Macrocytic anaemia—B12, folate and marrow causes→Major haemorrhage & massive transfusion→Massive-transfusion monitoring chart→Monoclonal gammopathy and MGUS→Multiple myeloma→Myelodysplastic syndromes (MDS)→Myeloproliferative neoplasms→Neutropenia, agranulocytosis & febrile neutropenia→Normocytic anaemia and anaemia of chronic disease→Other haematological malignancies→Pancytopenia, aplastic anaemia & marrow failure→Paroxysmal nocturnal haemoglobinuria→Peri-procedural anticoagulation and bridging→Rare genetic disorders→Red-cell exchange transfusion→Sickle-cell emergencies→Stem-cell collection and transplantation overview→Thalassaemia and transfusion-dependent anaemias→Therapeutic plasma exchange→Therapeutic venesection→Thrombocytopenia & ITP→Thrombocytosis—reactive versus clonal→Thrombophilia and antiphospholipid syndrome→Thrombophilia testing—indications and timing→TTP & thrombotic microangiopathy→Venous thrombosis at unusual sites→

Investigations & procedures

Anaemia and haemolysis investigation algorithm→Haematology visual atlas & investigations→Thrombocytopenia investigation algorithm→Transfusion-reaction investigation and reporting→

AMT Digital Health About Clinical governance

Clinical calculators · anticoagulation

Starting a DOAC

Calculate Cockcroft–Gault creatinine clearance, identify an indication-specific starting dose and complete the essential safety screen.

Prescribing support—not an autonomous prescriptionConfirm the indication, licensed product information, current BNF/local anticoagulation policy and patient-specific interactions before prescribing.

1 · TreatmentIndicationDOAC

2 · Cockcroft–Gault inputs

Age (years)SexWeight (kg)Creatinine (µmol/L)

Uses actual body weight. At weight extremes, oedema or low muscle mass, verify the appropriate weight scalar and renal estimate with pharmacy/local policy.

3 · Stop and interaction screenActive clinically significant bleedingMechanical prosthetic valve or moderate/severe rheumatic mitral stenosisKnown high-risk antiphospholipid syndromePregnant, breastfeeding or trying to conceiveHepatic disease with coagulopathy / clinically relevant bleeding riskStrong P-gp/CYP3A4 inhibitor or specified P-gp inhibitorStrong P-gp/CYP3A4 inducerAntiplatelet, NSAID or another anticoagulant

Calculated result

Cockcroft–Gault CrCl72 mL/min

Indicative Apixaban regimen5 mg twice daily

Standard NVAF dose.

Baseline: FBC, U&E/creatinine, LFT, weight and clotting screen.
Confirm haemoglobin/platelets, bleeding history, adherence, last anticoagulant dose and planned procedures.
For AF, document stroke and bleeding-risk assessment; bleeding scores should prompt risk-factor modification, not automatic withholding.
Give written counselling, an anticoagulant alert card and a monitoring/review date.

NICE AF guidance ↗NHS SPS monitoring ↗BNF anticoagulants ↗