NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Novel Oral Anticoagulants (NOACs): update


Inclusion of the NOACs (dabigatran, rivaroxaban, apixaban) on the NHSGGC Formulary is established for existing patients with non-valvular atrial fibrillation (AF) who are intolerant of, or poorly controlled on, warfarin. To date there has been cautious uptake of these new agents.


Supporting guidance is on GGC Prescribing which includes information to guide choice of NOAC and how to manage the transition period. Potentially suitable patients, with poor INR control (time in target range <60%), will be identified and highlighted to general practice by the Glasgow & Clyde Anticoagulation Service (GCAS).  


The role of NOACs in the management of new patients has been under consideration and the Heart Managed Clinical Network (MCN) is undertaking a review of the NHSGGC AF guideline. This will include a change which will support the option of prescribing a NOAC as a first-line alternative to warfarin where anticoagulation is indicated in patients newly diagnosed with non-valvular AF. The Formulary status of dabigatran and apixaban has been updated to reflect this change. The position for rivaroxaban is unchanged and is in line with SMC advice.


Patients are at high risk of a stroke before they are fully anticoagulated and the NOACs have the advantage of a quicker onset of action compared to warfarin, and can be immediately prescribed by the GP rather than awaiting referral to GCAS. The significant financial implications of introducing NOACs for new diagnoses of AF have been included in the Board’s financial plan for medicines for 2014/15. The updated guideline will be communicated in due course through PostScript and the Heart MCN.


Patients who are well controlled on warfarin should remain on warfarin; a switch to NOAC in these patients is discouraged and remains non-Formulary.


Next article: New oral therapies for multiple sclerosis