NICE summary – Edoxaban for preventing stroke and systemic embolism in people with NVAF

The National Institute for Health and Care Excellence (NICE) has released new guidance on the anti-blood clotting drug edoxaban (Lixiana, Daiichi Sankyo) as an option for preventing stroke and systemic embolism (blood clots) in adults with non-valvular atrial fibrillation (NVAF) who have one or more further risk factors. The guideline, Edoxaban for preventing stroke and systemic embolism in people with non-valvular atrial fibrillation, has had its key areas summarised for primary care professionals and will be distributed with the next issue of Nursing in Practiceand Pulse. The summary, produced with approval from NICE, focuses on the technology, a summary of the Appraisal Committee’s key conclusions, and implementation of edoxaban. NVAF is a heart rhythm disorder affecting the top two chambers of the heart (atria). This causes the heart to beat irregularly and – occasionally – too fast, so it cannot efficiently pump blood around the body. This can allow clots to form where the blood moves too slowly. These clots can then be carried to blood vessels in the brain, causing potentially deadly blockages that result in a stroke. The condition affects around 800, 000 people in the UK, but it’s thought that around 250, 000 others may be undiagnosed. Symptoms can include heart palpitations, dizziness, shortness of breath and fatigue. The risk of stroke can be substantially reduced by drugs such as warfarin that prevent the blood from clotting (anticoagulants). Edoxaban is an oral anticoagulant that directly inhibits factor X (factor Xa), which is a key component in the formation of blood clots. Commenting on NICE’s guidance, Professor Carole Longson, NICE health technology evaluation centre director, said: “Many people with NVAF find taking warfarin difficult because, among other things, it requires regular monitoring and dose adjustments and can interact with many foods and other drugs. Because edoxaban, like the other newer agents, doesn’t require frequent blood tests to monitor treatment, it represents a significant potential benefit for many people with NVAF. “The Committee concluded that, taking all the evidence into account, edoxaban is clinically and cost effective compared with warfarin and can be recommended as an alternative to warfarin for preventing stroke and systemic embolism, for people with NVAF who have 1 or more additional risk factors for stroke.” It is now available online here.