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NICE guidelines on atrial fibrillation discourage aspirin use

Health watchdog encourages greater NHS use of new anticoagulant drugs

UK flag New guidance published in the UK is seeking to prevent thousands of strokes in people with the common heart rhythm disorder atrial fibrillation (AF) through increased use of anticoagulant drugs.

In a first for the National Institute of Health and Care Excellence (NICE), the updated guidelines on the management of AF are accompanied by a consensus statement - developed with industry and other healthcare bodies - to make sure eligible patients get access to the best therapy.

The main departure from prior guidance is that aspirin should not be used in AF simply to reduce the risk of stroke, as it is not as effective as novel anticoagulants (NOACs) - namely Bayer/Johnson & Johnson's Xarelto (rivaroxaban), Boehringer Ingelheim's Pradaxa (dabigatran) and Pfizer/Bristol-Myers Squibb's Eliquis (apixaban) - and causes more bleeding side effects.

Doctors are also advised to use a new tool - called the CHA2DS2-VASc test - to assess a patient's risk of stroke in order to determine whether or not they need to be prescribed the blood-thinning drugs.

AF affects around 800,000 people in the UK and is sometimes described as the 'silent killer', as a sizeable proportion of individuals are unaware they have the condition.

Patients with AF are five times more likely to experience a stroke but, while these can be avoided using NOACs or the older anticoagulant warfarin, currently less than half of the eligible patients in the UK receive them.

Warfarin is effective and cheap - and still supported by the new guidelines - even though the drug requires monitoring and dosage adjustments to make sure it is working properly. NICE indicates that when patient monitoring is issue a NOAC may be preferable. 

Doctors are being asked to review their AF patients and switch them to anticoagulant therapy if they are on aspirin to prevent strokes, although it is stressed that aspirin remains a valuable drug to prevent heart attacks and strokes in other circumstances. It is estimated that around 200,000 AF patients in the UK are taking the drug.

The accompanying consensus statement has been drawn up by the NICE Implementation Collaborative (NIC), a body formed in 2012 to bring the agency together with representatives from the NHS, the life sciences industry, healthcare professional bodies, key health organisations and the public.

The document "summarises key aspects of the new guidance around the use of the new generation of oral anticoagulants and recommends ways in which local practices can be adapted to deliver high quality treatment for people with AF," said NICE consultant clinical adviser Prof Neal Maskrey.

Alongside the guidelines and consensus statement, NICE has also developed a new Patient Decision Aid to help people weigh up the advantages and disadvantages of the various treatment options available.

The publication of the AF guidance and first consensus statement has been welcomed by the Association of the British Pharmaceutical Industry (ABPI), which is a member of the NIC.

"Despite NOACs being approved by NICE as being effective, reliable and with favourable safety profiles compared to warfarin, there are still barriers preventing their use," said the ABPI's chief executive Stephen Whitehead.

"As the epidemic of AF continues to increase, the consensus statement quite rightly calls for these medicines to be made available for prescribing within their licensed indications, and to be automatically included in local formularies without further adaption of guidance at a local organisation level," he added.

The ABPI also called for a review of local arrangements for anticoagulant provision along with agreed protocols across primary and secondary care for the initiation of NOAC therapy.

Article by
Phil Taylor

18th June 2014

From: Sales, Marketing, Healthcare

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