Transitioning eligible VTE patients to a DOAC

Given the current pressures on healthcare services including anticoagulation services, we would like to offer some information which may support you in managing your DVT & PE patients and reduce the need for additional clinic or pharmacy visits.

Transition Guide

Following the publication of Government (NHS England) guidance2, endorsed by the British Haematological Society, the Royal Pharmaceutical Society and the Primary Care Pharmacy Association, to transition patients from VKA to a DOAC, we have developed some resources to support this transition. Please find below a link to download a simple guide for transitioning from VKA or LWMH to rivaroxaban for your patients undergoing anticoagulation treatment for confirmed DVT/PE or continued treatment for secondary prevention.

Latest NICE VTE Guidelines March 2020 recommend the use of DOACs for confirmed proximal DVT or PE (including patients with active cancer) and for long term anticoagulation to prevent VTE recurrence.3

The Einstein PE & DVT trials provide evidence for the use of rivaroxaban in acute treatment, and the Einstein CHOICE trial showed rivaroxaban, both treatment dose (20mg) and a thromboprophylactic dose (10 mg) to be superior to aspirin 100mg for preventing VTE recurrence associated with a rate of bleeding similar to that with aspirin (<1% of patients experienced major bleeding).4-6

Rivaroxaban Treatment Initiation Pack

For newly diagnosed DVT and PE patients, the initiation pack for rivaroxaban is available to simplify the first month of treatment. This pack includes three weeks of the 15mg b.d. dose, optimally protecting patients during the initial high-risk period7, and one week of the reduced dose (20mg o.d.) for continued treatment, thereby removing the need for an additional hospital visit to reduce the dose. Patients can be maintained on this dose for 3-6 months based on an individual patient’s assessed risk.1*

Initiation Starter Pack

If you'd like additional support or for more information on how to optimally manage VTE patients with rivaroxaban, speak to your local Bayer representative.

PE – pulmonary embolism; DVT – deep vein thrombosis; VTE – venous thromboembolism; DOACs – direct oral anticoagulants; NICE – National Institute for Health and Care Excellence. LWMH; low weight molecular heparin.

* Please refer to the SmPC for full prescribing information

References
1. Xarelto (rivaroxaban). Summary of Product Characteristics, as approved by the European Commission
2. NHS England. March 2020. Clinical guide for the management of anticoagulant services during the coronavirus pandemic. www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0077-Specialty-guide_ Anticoagulant-services-and-coronavirus-v1-31-March.pdf Accessed April 2020
3. NICE. 2020. Venous thromboembolic diseases: diagnosis, management and thrombophilia testing [NG158]. www.nice.org.uk/guidance/NG158 Accessed April 2020
4. Bauersachs R., et al. N Engl J Med. 2010; 363(26):2499-510
5. Büller HR, et al. N Engl J Med. 2012;366(14):1287-97
6. Weitz JI, et al. N Engl J Med 2017; 376(12):1211-22
7. Limone BL, et al. Thromb Res. 2013;132:420-426

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