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NICE approves new treatment for stroke prevention

8037901-article-hospitaldoctorsPatients with atrial fibrillation can now be offered rivaroxaban (Xarelto), as an alternative to warfarin, in order to reduce their risk of stroke and blood clots, says NICE.

The advice comes just two months after NICE also approved dabigatran for the same condition.

Atrial fibrillation (AF) is a condition that affects the heart causing it to beat irregularly, and occasionally, too fast. When this happens, the heart cannot pump blood around the body efficiently.

People with AF are at higher risk of developing blood clots and subsequent stroke. The risk of stroke can be significantly reduced by using anticoagulants such as warfarin.

While warfarin is typically used for preventing strokes, some patients can find it inconvenient due to the careful monitoring and regular blood tests required to ensure that their blood clotting properties remain within normal limits..

Rivaroxaban is an anticoagulant that is taken orally. It stops a substance called Factor Xa from working, which is necessary for the formation of thrombin and fibrin - key components in the formation of blood clots.

In final guidance published today, NICE recommends rivaroxaban for people with nonvalvular atrial fibrillation, who have one or more risk factors.

These include congestive heart failure, hypertension, if they are aged 75 years or older, have diabetes mellitus, or have had prior stroke or transient ischaemic attack.

Decisions on whether to start treatment with the drug should be made following an informed discussion between the clinician and the patient regarding the risks and benefits of rivaroxaban in comparison with warfarin.

NICE also says that people who are currently taking warfarin should consider the potential risks and benefits of switching to rivaroxaban in light of their international normalised ratio control.

The positive recommendation for rivaroxaban follows the recent publication of final guidance from NICE on dabigatran, which was also recommended for AF.

Professor Carole Longson, Director of the Health Technology Evaluation Centre at NICE, said: “We know that some people taking warfarin can find it difficult to maintain their blood clotting at a proper level. Rivaroxaban, like dabigatran etexilate, which NICE recently approved as an option for this indication, can benefit people with AF.

“We are therefore pleased to recommend rivaroxaban as another cost-effective option for the prevention of stroke and systemic embolism in people with atrial fibrillation.”

23 May 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.