NICE recommends rivaroxaban to prevent blood clots in heart attack patients

Extends the pill’s growing list of NICE recommendations

In final draft guidance published this week NICE is recommending rivaroxaban (Xarelto, Bayer Healthcare), in combination with clopidogrel and aspirin, or with aspirin alone, as an option for preventing blood clots in people who have had an acute coronary syndrome.

Rivaroxaban is licensed for the prevention of blood clots in adults who have an acute coronary syndrome severe enough to result in the release of cardiac biomarkers into the blood that show heart muscle has been damaged.

Professor Carole Longson, NICE health technology evaluation centre director, said: “Based on the evidence considered, the independent appraisal committee concluded that rivaroxaban, in combination with aspirin plus clopidogrel or with aspirin alone, was more effective than aspirin plus clopidogrel or aspirin alone for preventing further cardiovascular deaths and heart attacks in people with acute coronary syndrome and raised cardiac biomarkers. The Committee therefore recommended rivaroxaban as a cost-effective use of NHS resources.

“Because rivaroxaban is associated with a higher risk of causing bleeding than clopidogrel in combination with aspirin or aspirin alone, the draft guidance recommends that before starting treatment doctors should carry out a careful assessment of a person’s bleeding risk.

“The decision to start treatment should be made after an informed discussion between the doctor and patient about the benefits and risks of rivaroxaban. Also, because there is limited experience of treatment with rivaroxaban up to 24 months, the draft guidance recommends careful consideration should be given to whether treatment is continued beyond 12 months.”

The draft guidance considers the use of rivaroxaban to prevent further blood clots in adults who have had a heart attack.

In unstable angina, damage to the heart is not severe enough to result in the release of biomarkers into the blood so this condition is not considered in the draft guidance.

The committee concluded that rivaroxaban 2.5mg twice-daily in combination with aspirin plus clopidogrel or with aspirin alone was more effective than aspirin plus clopidogrel or aspirin alone for preventing further cardiovascular deaths and myocardial infarction in people with acute coronary syndrome and raised cardiac biomarkers.

The list price of rivaroxaban is £58.88 per 2.5mg, 56 capsule pack. The license dose is 2.5mg twice daily which equates to a price of £2.10 per day – assuming treatment duration of 12 months, the total acquisition costs are expected to be £766.50.

The drug also has a number of other licences, including the treatment and prevention of deep vein thrombosis and pulmonary embolism, the prevention of stroke in people with atrial fibrillation and the prevention of venous thromboembolism after total hip or total knee replacement in adults.

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