Options for local implementation
NICE has issued technology appraisal guidance on the use of the 4 non-vitamin K antagonist oral anticoagulants (NOACs), apixaban, dabigatran etexilate, edoxaban and rivaroxaban, in several clinical settings. All 4 NOACs must be included in local formularies for use in line with this guidance, with no additional funding or formulary restrictions.
All anticoagulants are associated with several patient safety hazards. In 2007, the National Patient Safety Agency (NPSA), which is now part of NHS Improvement, issued a patient safety alert about anticoagulants. Be aware of the principles within this, which are still applicable to practice.
Review and, if appropriate, optimise prescribing and local policies relating to anticoagulants, including NOACs, to ensure these are in line with NICE guidance and the principles of the NPSA safety alert.
Several factors are likely to affect the choice of anticoagulant for an individual person. NICE has produced a patient decision aid and endorsed a decision support tool to support discussions about anticoagulant options for people with atrial fibrillation.