Transcript New Oral Anticoagulants (NOACS) Dabigatran and Rivaroxaban

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
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
Rivaroxaban
Prothrombin (Factor II)
Factor Xa
Dabigatran
Thrombin (Factor IIa)
Fibrinogen (Factor I)
Fibrin
Dabigatran etexilate
• Pradaxa® capsules 75mg, 110mg, 150mg
• Dose (AF):
150mg BD
110mg BD Age ≥80 years
Concomitant verapamil
High risk of bleeding
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
Rivaroxaban
• Xarelto® tablets 10mg, 15mg, 20mg
• Dose (AF):
20mg OD
15mg OD
Moderate/Severe renal impairment
(avoid if CrCl<15mL/min)
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%
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
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
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