New stroke prevention treatment recommended by NICE

Patients with atrial fibrilation can now be offered apixaban (Eliquis) as an alternative to warfarin to reduce the risk of stroke and blood clots, says NICE.

Patients with atrial fibrilation can now be offered apixaban (Eliquis) as an alternative to warfarin to reduce the risk of stroke and blood clots, says NICE.

Atrial fibrillation (AF) is the most common cause of irregular heart beat. It can cause the heart rhythm to become disorganised, and on occasion too fast, leading to the inefficient pumping of blood around the body.

People who have AF have a greater likelihood of developing blood clots and subsequent stroke. This risk can be significantly reduced through the use of anticoagulants.

However, some patients can find that certain anticoagulants such as warfarin are inconvenient and uncomfortable to use, since they need careful monitoring and regular blood tests to ensure the blood clotting properties remain within normal limits.

NICE recommends that apixaban can be used as an option for the prevention of stroke and systemic embolism in patients with non-valvular AF and one or more risk factors.

These factors include prior stroke or ischaemic attack, the person taking the drug is aged 75 years or older, or has hypertension, diabetes mellitus, or has symptomatic heart failure of New York Heart Association class 2 or higher.

Apixaban received its licence for this indication in November 2012, and is one of just 17 single technology appraisals from NICE that has been fast-tracked to a final appraisal determination without requiring the prior publication of an appraisal consultation document.

The new recommendations for apixaban follow guidance from NICE on rivaroxabanand dabigatran etexilate, which have both also been approved as an alternative to warfarin for this indication.

Professor Carole Longson, Director at the Health Technology Evaluation Centre, said: "Atrial fibrillation can be a distressing condition and people with it have an increased risk of suffering a stroke.

"Many people with the condition find it difficult to comply with the most commonly used antithrombotic, warfarin, because, among other things, its use requires regular monitoring of the blood's clotting properties and dose adjustments which can cause disruption and inconvenience. It also has multiple interactions with food, alcohol and drugs that can cause further inconvenience.

"The Appraisal Committee heard from patient experts that warfarin can have a greater impact on a person's quality of life than atrial fibrillation itself."

She added: "Apixaban, like rivaroxaban anddabigatran etexilate, which NICE recently approved as options for this indication, has potential benefits for people with AF in these circumstances because it doesn't require such regular monitoring and dose adjustments.

"From the evidence submitted, the Committee concluded that apixaban was more clinically effective than warfarin for the primary efficacy outcome of reducing stroke and systemic embolism."