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Anticoagulants available for your patients

Anticoagulation for patients with non-valvular AF (NVAF) may be with a vitamin K antagonist (VKA) or with a non-VKA oral anticoagulant (NOAC).1 VKAs (e.g. warfarin) are traditional anticoagulants with established efficacy and safety profiles, but with several challenges such as a narrow therapeutic window, numerous food and drug interactions and inconveniences for patients.2,3 NOACs offer some benefits over traditional VKAs:2–7

  • Comparable or improved efficacy profiles vs. VKAs
  • Comparable or improved safety (bleeding) profiles vs. VKAs
  • No need for routine INR monitoring
  • Few food and less drug interactions, and
  • Fixed dosing

Four NOACs – namely apixaban, dabigatran, edoxaban and rivaroxaban – are approved for the prevention of stroke and systemic embolism in patients with NVAF with at least one additional risk factor for stroke/systemic embolism, for which some patients are not eligible:4–7

PFI_ELI_NVAF_UK

[References for figure: 4. Apixaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2878/smpc. Accessed July 2019. 5. Rivaroxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2793/smpc. Accessed July 2019. 6. Dabigatran Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/4703/smpc. Accessed July 2019. 7. Edoxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/6906/smpc. Accessed July 2019.]

The properties of VKAs and NOACs are briefly summarised below. Please refer to the SmPC for more information on each product:

Choosing VKA or NOACs
VKA properties2


NOAC properties2


[References for figure: 2. Lin YP, et al. Medicine (Baltimore) 2015;94:e1627; 8. Connolly SJ, et al. N Engl J Med 2009;361:1139–51; 9. Patel MR, et al. N Engl J Med 2011;365:883–91; 10. Granger CB, et al. N Engl J Med 2011;365:981–92; 11. Giugliano RP, et al. N Engl J Med 2013;369:2093–104; 12. Mekaj YH, et al. Ther Clin Risk Manag 2015;11:967–77; 13. Bauer KA. Hematology Am Soc Hematol Educ Program 2013;2013:464–70; 14. Raval AN, et al. Circulation 2017;135:e604–e633. DOI: 10.1161/CIR.0000000000000477; 15. Spyropoulos AC, et al. Blood 2012;120:2954–2962]

Case studies – patients suitable for NOACs

The properties of NOACs may make them preferable to VKA for most eligible and appropriate NVAF patients, for example those who would struggle to attend regular clinic visits or who already take several concomitant medications. Find out more through these downloadable case studies.

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Click here to view ELIQUIS (apixaban) prescribing and adverse event reporting information.

Abbreviations

INR = International Normalised Ratio NOAC = Non-VKA Oral Anticoagulant NVAF Non-Valvular Atrial Fibrillation NYHA = New York Heart Association TIA = Transient Ischaemic Attack VKA = Vitamin K Antagonist

References
  1. NICE. CG180. 2014. Available at: https://www.nice.org.uk/guidance/cg180. Accessed August 2019.
  2. Lin YP et al. Medicine (Baltimore) 2015; 94: e1627.
  3. Kirchhof P et al. Eur Heart J 2016; 37: 2893–2962.
  4. Apixaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2878/smpc. Accessed August 2019.
  5. Rivaroxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/2793/smpc. Accessed August 2019.
  6. Dabigatran Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/4703/smpc. Accessed August 2019.
  7. Edoxaban Summary of Product Characteristics. Available at: www.medicines.org.uk/emc/product/6906/smpc. Accessed August 2019.
  8. Connolly SJ, et al. N Engl J Med 2009;361:1139–51.
  9. Patel MR, et al. N Engl J Med 2011;365:883–91.
  10. Granger CB, et al. N Engl J Med 2011;365:981–92.
  11. Giugliano RP, et al. N Engl J Med 2013;369:2093–104.
  12. Mekaj YH, et al. Ther Clin Risk Manag 2015:11:967–77.
  13. Bauer KA. Hematology Am Soc Hematol Educ Program 2013;2013:464–70.
  14. Raval AN, et al. Circulation 2017;135:e604–e633. DOI: 10.1161/CIR.0000000000000477].
  15. Spyropoulos A et al. Blood 2012;120:2954–2962.

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Job code: 432UK1900440-01
Date of preparation: September 2019

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