Transitioning eligible NVAF patients from warfarin to a DOAC

Transitioning eligible NVAF patients from warfarin to a DOAC

Xarelto has been proven to offer similar protection to warfarin from stroke and systemic embolism and no significant difference in the primary safety endpoint of major or clinically relevant non-major bleeding, vs warfarin.2,* Xarelto does not require routine monitoring of exposure.6 It is important to note, not all NVAF patients on warfarin will be suitable for a DOAC switch. Please refer to the recent full guidance published by NHS England10 and the Royal Pharmaceutical Society, referenced above, to identify the appropriate patient to be transitioned onto a DOAC.1

Rivaroxaban may provide an option as it has been robustly tested in a larger proportion of high-risk patients (CHADS2 ≥3) in ROCKET AF, compared to other DOAC RCTs, including patients with comorbidities such as moderate renal impairment (creatine clearance 30 – 49 ml/min), diabetes and heart failure.2-5

Rivaroxaban also offers simple once a day dosing, with a dose reduction from 20mg od to 15mg od in those with moderate (creatine clearance 30 – 49 ml/min) or severe (creative clearance 15-29 ml/min) renal impairment.**,6 Rivaroxaban is the only DOAC with a single consideration for dose reduction.6-9

Switching Guide

Download a simple guide to transitioning from a vitamin K antagonist (VKA) to Xarelto for your nonvalvular atrial fibrillation (NVAF) patients.11

Dosing Information

Download non-vitamin K oral anticoagulant dosing algorithm for patients with non-valvular atrial fibrillation and renal impairment:

Counselling videos

Bayer have developed a number of counselling videos to support the discussion between physician and non-valvular atrial fibrillation patient when transitioning from warfarin to a DOAC:

A poorly controlled warfarin patient transitioning to DOAC with reassurance to the patient regarding efficacy and safety profiles


A poorly controlled warfarin patient requesting aspirin instead of warfarin


The importance of adherence to DOACs and discussing the bleeding risk versus the stroke risk


Explaining the importance of adherence to DOACs and discussion around initial and on-going monitoring involved


The physician featured in the clips is Dr Yassir Javaid MA (Cantab) FRCP FRCGP PGDip, Cardiovascular and Diabetes Lead Nene CCG Primary Care Cardiovascular lead, East Midlands Clinical Network and RCGP Clinical Adviser for Cardiology. He qualified from Cambridge University and completed his GP VTS training in Northampton. He has an interest in cardiology and echocardiography and was a clinical lead in the Northamptonshire Community Cardiology service, which had a focus on patients with heart failure and valve disease. Dr Yassir Javaid fully endorses these educational counselling videos and has consented to them being used on this website.

Footnotes
*In the per-protocol population stroke or systemic embolism occurred in 188 patients in the rivaroxaban group (1.7% per year) and in 241 patients in the warfarin group (2.2% per year) (hazard ratio in the rivaroxaban group, 0.79; 95% confidence interval [CI], 0.66 to 0.96; P<0.001 for noninferiority). In safety population on treatment the Major and clinically relevant nonmajor bleeding occurred in 1475 patients in the rivaroxaban group and in 1449 patients in the warfarin group (14.9% and 14.5% per year, respectively; hazard ratio in the rivaroxaban group, 1.03; 95% CI, 0.96 to 1.11; P = 0.44).
**Use of Xarelto is not recommended in those with severe renal impairment (CrCl <15 ml/min). Xarelto can be used in those with a CrCl 15-29 ml/min, provided it is done with caution.

References
1. Royal Pharmaceutical Society www.rpharms.com Accessed 30 March 2020.
2. Patel MR, et al. N Engl J Med. 2011; 365(10):883–91.
3. Granger CB, et al. N Engl J Med. 2011;365(11):981–92.
4. Giugliano RP, et al. N Engl J Med. 2013;369(22):2093–104
5. Connolly SJ, et al. N Engl J Med. 2009;361(12):1139–51.
6. Xarelto (rivaroxaban). Summary of Product Characteristics, as approved by the European Commission.
7. Eliquis (apixaban). Summary of Product Characteristics, as approved by the European Commission.
8. Pradaxa (dabigatran). Summary of Product Characteristics, as approved by the European Commission.
9. Lixana (edoxaban). Summary of Product Characteristics, as approved by the European Commission.
10. NHS England www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0077-Specialty-guide_ Anticoagulant-services-and-coronavirus-v1-31-March.pdf Accessed 15th April 2020.
11. Xarelto (rivaroxaban). Summary of Product Characteristics, as approved by the European Commission.

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