www.thrombosis-charity.org.uk
Access to the new anticoagulants: A joint statement from Anticoagulation Europe & Lifeblood: The Thrombosis Charity Anticoagulation Europe and Lifeblood are both charities that support patients requiring anticoagulation in the UK. Recently new oral anticoagulants (NOACS) have become available to be used in the prevention of stroke in non-valvular atrial fibrillation and the treatment and secondary prevention of deep vein thrombosis and pulmonary embolism. Previously only warfarin (and other vitamin K antagonists) were available. The new oral anticoagulants are as good as warfarin in reducing the risk of blood clots, and also have some convenience advantages over warfarin in that they do not require attendance for anticoagulant monitoring and are also cost effective. There are now National Institute for Health and Care Excellence (NICE) guidelines in place that recommend that there should be equal access to the NOACs and warfarin in the prevention of stroke in those with non-valvular atrial fibrillation1 and in the management of deep vein thrombosis and pulmonary embolism.2 The NICE Implementation Collaborative (NIC) has recently published a consensus report3, which makes recommendations for how barriers to implementation may be overcome locally to facilitate appropriate use of these drugs. The report is endorsed by the Royal Colleges of Physicians, GPs, Nursing, Pharmaceutical Society and our respective charities. Lifeblood and Anticoagulation Europe are both very concerned that the NICE recommendations that there should be equal access to VKAs (warfarin) and NOACs in the NICE approved indications are not being implemented. The NHS constitution states that patients should not be denied access to NICE approved drugs. And yet we know of many examples where patients starting anticoagulation, or those on long term anticoagulation who might wish to switch from warfarin, don’t appear to have been offered the opportunity to consider using a NOAC. In some cases NOAC prescriptions are limited by Clinical Commissioning Groups (CCGs) to secondary care. In some settings patients may be referred to a special clinic for the prescription of a NOAC, resulting in time consuming appointments and waste of NHS resources 1
http://www.nice.org.uk/Guidance/CG180
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http://www.nice.org.uk/guidance/ta287/chapter/sources-of-evidence-considered-by-thecommittee 3
https://www.nice.org.uk/guidance/cg180/resources/cg180-atrial-fibrillation-nic-consensusstatement-on-the-use-of-noacs2 Reference: NICE Implementation Collaborative Consensus: Supporting local implementation of NOACs in non-valvular atrial fibrillation.
www.thrombosis-charity.org.uk
We as patient support organisations demand:
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There must be equality of access to a NOAC and vitamin K antagonists such as warfarin for all patients who require anticoagulation as recommended by NICE and SMC guidelines When starting anticoagulation patients must be adequately informed of the benefits and risks of NOACs and vitamin K antagonists such as warfarin so they can make an informed choice with their health professional Patients who are currently on vitamin K antagonists such as warfarin, and who have poor anticoagulation control (time in range less than 65%) should be reviewed to consider whether they should be switched to a NOACS That both primary and secondary care health professionals are able to prescribe NOACs, so that patients receive NOACs from the health professional who makes the decision to use them and receives them at the earliest opportunity. Those patients who commence on a NOAC must be able to access the treatment consistently across any setting and will not be restricted by local prescribing directives
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In order to achieve the above demands, education about NOACs in primary health care must become an NHS priority
If you have been denied access to NOACs, please tell us by emailing: Diane Eaton: anticoagulation@ntlworld.com Or Katherine Johnson: katherine@lifeblood-charity.com