1. Educational Event
23rd & 24th January 2013
West Suffolk Hospital Education Centre
New Oral Anticoagulants (NOACs) Dabigatran and Rivaroxaban for the prevention of stroke and systemic embolism in nonvalvular atrial fibrillation
Clinical Overview & NICE TA Guidance
Emma Harris
Medicines Management Pharmacist
West Suffolk Clinical Commissioning Group

2. Clinical Overview of the NOACs
Prophylaxis of stroke and systemic embolism in nonvalvular AF
Dabigatran etexilate
prodrug
rapidly absorbed after oral administration and converted to dabigatran
direct thrombin inhibitor
Rivaroxaban
direct factor Xa inhibitor

3. Rivaroxaban
Prothrombin (Factor II) Factor Xa Thrombin (Factor IIa) Fibrinogen (Factor I) Fibrin
Dabigatran

4. Dabigatran etexilate Pradaxa® capsules 75mg, 110mg, 150mg Dose (AF):
150mg BD
110mg BD Age ≥80 years
Concomitant verapamil
High risk of bleeding

5. Dabigatran etexilate Dose (AF): 110mg or 150mg BD Age 75-80 years
Moderate renal impairment (avoid if CrCl<30mL/min) Gastritis, Oesophagitis, GORD Other patients at increased risk of bleeding

6. Rivaroxaban Xarelto® tablets 10mg, 15mg, 20mg Dose (AF): 20mg OD
Moderate/Severe renal impairment
(avoid if CrCl<15mL/min)

7. NICE Technology Appraisal Guidance 249
March 2012
Dabigatran etexilate for the prevention of stroke and systemic embolism in AF
Recommended as an option in people with nonvalvular AF with one or more of the following risk factors:
previous stroke, transient ischaemic attack or systemic embolism
left ventricular ejection fraction below 40%

8. NICE Technology Appraisal Guidance 249
symptomatic heart failure of NYHA ≥class 2
age 75 years or older
age 65 years or older with one of the following: diabetes mellitus
coronary artery disease hypertension
Informed discussion between clinician and patient on the risks and benefits of:
dabigatran compared to warfarin
switching to dabigatran from warfarin

9. NICE Technology Appraisal Guidance 256
May 2012
Rivaroxaban for the prevention of stroke and systemic embolism in people with AF
Recommended as an option in people with nonvalvular AF with one or more risk factors such as:
congestive heart failure
hypertension
age 75 years or older
diabetes mellitus
prior stroke or transient ischaemic attack

10. NICE Technology Appraisal Guidance 256
Informed discussion between clinician and patient on the risks and benefits of:
rivaroxaban compared to warfarin
switching to rivaroxaban from warfarin