The UK National Institute for Health and Clinical Excellence (NICE) recommends rivaroxaban, as an alternative to warfarin, to patients with atrial fibrillation (AF) in order to reduce their risk for stroke and systemic embolism.

The final guidance comes just two months after NICE also approved dabigatran for the same condition.
Patients with AF are at an increased risk for developing blood clots and subsequent stroke. The risk for stroke can be significantly reduced by using anticoagulants such as warfarin.

However, 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 directly inhibits activated factor X, a key component in the formation of blood clots.

In the published guidance, NICE states rivaroxaban treatment should be recommended to patients if they have nonvalvular AF and one or more of the following risk factors: congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, prior stroke or transient ischemic attack.

It also states that the decision about whether to start treatment with rivaroxaban should be made after an informed discussion between the clinician and the patient about the risks and benefits of rivaroxaban compared with warfarin, and noting the limited direct trial evidence for people with a low risk of stroke (CHADS2 score of less than 2).

For people who are taking warfarin, the potential risks and benefits of switching to rivaroxaban should be considered in light of their level of international normalized ratio control.

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.”

By Nikki Withers