Tag Archives: dabigatran

Approximately 20–30% of patients with AF, who are continuously taking an oral anticoagulant to reduce their risk of AF-related stroke, have coexisting coronary artery disease and may require PCI. The current practice of administering triple therapy with warfarin and two antiplatelet agents in patients with AF after a PCI is associated with high rates of major bleeding. RE-DUAL PCI tested an alternative treatment strategy: dual therapy with dabigatran and a single antiplatelet agent (P2Y12 inhibitor). Selected for one of the meeting’s hotline sessions and simultaneously published in the New England Journal of Medicine (https://doi.org/10.

Approval for new heart failure treatment A breakthrough drug for the treatment of chronic heart failure is now available in the UK.  The new drug sacubitril/valsartan (Entresto®, Novartis) has been approved for the treatment of adults with symptomatic heart failure with reduced left ventricular ejection fraction (HFREF). Sacubitril/valsartan – the first drug in the angiotensin receptor neprilysin inhibitor (ARNI) class of drugs – was found to be superior to an evidence-based dose of the angiotensin-converting enzyme (ACE) inhibitor, enalapril, in the PARADIGM-HF study, the largest heart failure study conducted to date. PARADIGM-HF (Pros

Dear Sirs, We read with interest Diana Gorog’s recent article on the uptake of non-vitamin K oral anticoagulants (NOACS) in the UK.1 She drew attention to the slow uptake of these agents in the UK as opposed to many countries in Europe, and certainly the USA, and to the role that local medicines management committees (MMCs) may play in this. While the National Institute for Health and Care Excellence (NICE) guidance regarding all three NOACs available in the UK (apixaban, dabigatran and rivaroxaban) is that they should be available as an option for stroke prevention in non-valvular atrial fibrillation (AF), many MMCs in the UK have sought t

We read with interest Diana Gorog’s recent article on the uptake of non-vitamin K oral anticoagulants (NOACS) in the UK.1 She drew attention to the slow uptake of these agents in the UK as opposed to many countries in Europe, and certainly the USA, and to the role that local medicines management committees (MMCs) may play in this. While the National Institute for Health and Care Excellence (NICE) guidance regarding all three NOACs available in the UK (apixaban, dabigatran and rivaroxaban) is that they should be available as an option for stroke prevention in non-valvular atrial fibrillation (AF), many MMCs in the UK have sought to control p

NICE NOAC guidance The National Institute for Health and Care Excellence (NICE) has recently published two recommendations on the use of novel oral anticoagulants (NOACs). NICE has recommended the NOAC dabigatran as an option for treating and preventing deep-vein thrombosis (DVT) and pulmonary embolism (PE) in adults (available in full at http://www.nice.org.uk/guidance/ta327) A final appraisal determination has also been issued for the NOAC rivaroxaban. It recommends it is an effective treatment option for preventing secondary events after acute coronary syndrome in patients with elevated cardiac biomarkers. Publication of full guidance is e

When the NOACs (novel oral anticoagulants) were introduced over three years ago, they promised to revitalise the management of conditions such as atrial fibrillation (AF), venous thromboembolism (VTE) and thromboprophylaxis after major joint replacement surgery. Rivaroxaban is currently available in multiple indications, including (but not limited to): prevention of stroke and systemic embolism in adult patients with non-valvular AF, treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and the prevention of recurrent DVT and PE in adults. For decades anticoagulant therapy in these conditions had relied on the vitamin K antagon

ESC guidelines and differences between NOACs Following the roll-out of the novel oral anticoagulants (NOACs), the European Society of Cardiology (ESC) published in 2012 a focused update of its guidelines for the management of atrial fibrillation (AF). Since the NOACs tested in clinical trials all showed at least non-inferiority when compared with vitamin K antagonists (VKAs), with a better safety profile, particularly with reduction in intracranial haemorrhage (ICH), the ESC 2012 guideline recommended NOACs as broadly preferable to VKAs in the vast majority of patients with non-valvular AF (NVAF).1 In 2013, the European Heart Rhythm Associati

New NICE guidance Dr Andrew Cox (St George’s, University of London) Stroke prevention is the major focus of the new National Institute of Health and Care Excellence (NICE) guidelines on atrial fibrillation (AF), which were discussed by Dr Campbell Cowan (Chair, NICE Guidelines Development Group) in one ‘Hot topics’ session at the meeting. This presentation was in anticipation of the release of the final version of the guidelines a fortnight following the conference. This limited discussion covered the already published draft guidance, but points from this draft which were discussed have since been confirmed in the published guidance

NICE draft guidance on acute heart failure published The draft acute heart failure clinical guideline from the National Institute of Health and Care Excellence (NICE) is now out for consultation with stakeholders. Guideline recommendations, available on http://www.nice.org.uk, include advice that people with suspected acute heart failure should be seen by a specialist team with a heart failure service at hospital. Currently practice is not standardised across hospitals and many patients are not treated by a dedicated service. …and also on ICDs and CRT   Draft technology appraisal guidance on the most clinically and cost-effective impla

Introduction Atrial fibrillation (AF) affects up to 2% of the population, its prevalence increasing with age; and, with the anticipated rise in the average age of the population, it is likely that the rate of AF will rise considerably. There is a significant risk of stroke, heart failure and mortality associated with AF. Both the National Institute for Health and Care Excellence (NICE) and National Health Service (NHS) Improvement have identified AF and stroke prevention as key areas for maintaining healthcare quality and improvements.1 A key feature is the early identification of patients at risk of thromboembolic events and the prompt init