Direct-acting oral anticoagulants set for wider use under NHS deal

Up to 610,000 more patients with atrial fibrillation (AF) are set to benefit from treatment with DOACs over the next 3 years following an agreement to expand access to the drugs, NHS England has announced.

More than 20,000 strokes and 5,000 deaths could be prevented as a result of the deal, NHS England says. 

Speaking at the NHS Providers conference on 16 November, NHS chief executive Amanda Pritchard said: 'The agreements struck by NHS England will save thousands of lives and prevent many more people suffering the debilitating effects of strokes by making this treatment available to hundreds of thousands more patients.

'The health service now has a proven track record of striking deals with manufacturers to ensure patients in England get cutting-edge care at a price which offers best value for taxpayers.'

There are four DOACs licensed to treat AF - apixaban, dabigatran, edoxaban and rivaroxaban - all of which have been recommended by NICE for use in people with AF who are at risk of stroke.

'Encouraging'

NHS England says the new agreement, which comes into force on 1 January 2022, will make DOACs more affordable, allowing the local NHS to provide them to 610,000 more patients. This figure includes patients newly diagnosed with AF and those who are already receiving treatment for the condition, but not those switching from warfarin.

In addition, up to £40 million will be invested in ‘Detect, Protect and Perfect’ pathway initiatives to help identify people with AF and move them onto 'effective and appropriate treatment'.

RCGP chair Professor Martin Marshall said: ‘GPs are at the forefront of identifying, treating and monitoring patients who are at risk of stroke. We understand how debilitating and life-changing having a stroke can be, so it’s always encouraging to see advances in the treatments available to manage atrial fibrillation and help prevent stroke. Greater availability of direct oral anticoagulants (DOACs) on the NHS will help to protect at-risk patients from having a stroke, and has the potential to save lives.'

Professor Marshall added: 'It is also positive that patients receiving DOACs require less monitoring by GPs or other members of our teams in comparison with other anticoagulation treatments. This is both convenient for patients and should help to free up GP time to deliver care to other patients in need of our care. It is important that GPs have all of the necessary information to prescribe and monitor patients on DOAC treatment appropriately, to take account of these advancements.'

MIMS provides a table summarising recommended doses of DOACs in AF, including dose adjustments required in patients with renal impairment and other conditions.