The National Institute of Health and Clinical Excellence (NICE) has published new guidance on the use of dabigatran (Pradaxa®) in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF).
Dabigatran is recommended as an option, within its licensed indication, in people with non-valvular atrial fibrillation with one or more of the following risk factors:
- previous stroke, transient ischaemic attack or systemic embolism
- left ventricular ejection fraction below 40%
- symptomatic heart failure of New York Heart Association (NYHA) class 2 or above
- age 75 years or older
- age 65 years or older with one of the following: diabetes mellitus, coronary artery disease or hypertension
It is recommended that the treatment initiation decision includes a discussion of the risks and benefits of dabigatran compared with warfarin.
It is also suggested that for patients who are already taking warfarin, the potential risks and benefits of switching to dabigatran are discussed with consideration of their level of international normalised ratio (INR) control.
Action: Clinicians should be aware of this new guidance and implement any necessary changes to practice.