This guideline is for Rivaroxaban, which is a Factor Xa inhibitor and has been approved for use in patients with nonvalvular AF and at least one of the following risk factors (which equates to a CHADS2 score of at least 1):
- 75 or older
- CVA or TIA
It is very expensive, but it’s main bonus is that no monitoring is needed. It has a similar safety profile to warfarin (it seems to cause more GI bleeds, but fewer intracranial bleeds – though only in those who’ve previously had warfarin). It is not inferior in effectiveness to warfarin. The study wasn’t good enough to compare it to dagabatrin.
The advice from NICE is to discuss the pros and cons with the patient. Those most likely to benefit are those whose INR is not well controlled. The trial didn’t show much for people with CHADS2 score of 1, so they may get less benefit.
Like dagabatrin, I suspect that there will be local guidance on it’s use – so I will await that before prescribing.