Comparison of DOACs for Atrial Fibrillation

Comparison tables are produced for prescribers and medicines management teams. They are designed to assist in prescribing and decision-making within a specific therapeutic area.

Several direct oral anticoagulants (DOACs) are licensed for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (NVAF). This comparison table allows prescribers and other healthcare professionals to easily compare the characteristics of these medicines. It has been prepared in response to the NHSE England National Procurement and Commissioning Recommendations published in January 2022.

This publication was updated in August 2022 to update guidance on use of DOACs in patients with AF with prosthetic heart valves. Further information was also added about use in extremes of bodyweight.

Monthly Horizon Scanning Report – April 2022

Monthly horizon scanning reports are designed to inform the NHS about new products, significant changes to product licenses, significant new guidance, and decisions that have been made by recognised bodies. 

This information is produced for use by NHS healthcare professionals. 

Drug Tariff Monitor

Overview

The purpose of this report is to present the predicted cost impact of category A, M and C drug tariff PartVIIIA price changes on primary care spending. The data is calculated by matching the ePACT2 prescribing data for the latest month available to the current prices listed in the NHSBSA Drug Tariff PartVIIIA. An adjustment is also made if necessary to the prescribing data of each drug to account for any difference in dispensing days between the 2 months. Data is presented at CCG and STP level.

If you have any queries about the content of the report please contact us at nuth.nyrdtc.rxsupp@nhs.net

Frequency

Quarterly

Data Period

April 2022 (Drug Tariff), February 2022 (ePACT2 Prescribing data)

Monthly Horizon Scanning Report – April 2021

Monthly horizon scanning reports are designed to inform the NHS about new products, significant changes to product licenses, significant new guidance, and decisions that have been made by recognised bodies. 

This information is produced for use by NHS healthcare professionals. 

Safer Medication Use – Opioids and gabapentinoids

Overview

Safer Medication Use is a bulletin series jointly produced by the Regional Drug and Therapeutics Centre and the Yellow Card Centre Northern and Yorkshire, which aims to promote safer prescribing. It discusses specific drug related safety problems, provides guidance to ensure safe, appropriate prescribing and raises awareness of adverse drug reaction detection and reporting.

The use of combination opioids and gabapentinoids is associated with an increased risk of adverse events. Gabapentinoid overdose is much more likely to be fatal when combined with opioids and there is a greater risk of gabapentinoid dependence in patients with a history of opioid use disorder.

There are limited circumstances when patients should be prescribed both an opioid and a gabapentinoid, and prescribers must carefully balance potential benefits against the risk of adverse effects from combination therapy. In such situations the opioid dose should be reduced before starting a gabapentinoid and the patient reviewed regularly. Treatment should be stopped if it is not effective or not tolerated but withdrawal of established opioids and / or gabapentinoid therapy should be done slowly to prevent discontinuation symptoms.

Postoperative patients who are prescribed long term gabapentinoids should be closely monitored for respiratory depression.