NPS MedicineWise finds little or no clinical benefit in switching to rivaroxaban for stroke prevention

With oral anticoagulant rivaroxaban set to be subsidised under the Pharmaceutical Benefits Scheme (PBS) for preventing stroke, NPS MedicineWise is urging people to talk to their doctor before stopping or making any changes to their anticoagulant medicines.

Rivaroxaban (Xarelto) will be subsidised from 1 August 2013 for preventing stroke in people with atrial fibrillation, a heart condition which increases the risk of harmful blood clots that cause stroke. It will also be subsidised for treating pulmonary embolism — a blood clot in the lung.

And while the change means more choice for consumers, NPS MedicineWise says that people who are already stable on warfarin — the mainstay of anticoagulant therapy for the past 50 years — may not benefit from switching to rivaroxaban.

NPS MedicineWise clinical adviser Dr Philippa Binns says that on balance, if warfarin is working well for you and your INR results are stable there is little or no clinical benefit in switching to rivaroxaban.

“While one of the perceived benefits of rivaroxaban is that you don’t need to have regular INR blood tests, it’s important to know that there is currently no equivalent test to monitor how well rivaroxaban is working in your body,” says Dr Binns.

“This means there’s currently no way to tell if you are at risk of bleeding or of having a blood clot.

“Even though you won’t need to have the INR blood tests, if you switch from warfarin to rivaroxaban or another anticoagulant, it’s still very important to have regular checks so your doctor can monitor your health.”

Dr Binns says people also need to be aware that the main side effect of all anticoagulants including rivaroxaban and warfarin is bleeding. However, unlike warfarin, there is currently no antidote if you start bleeding while taking rivaroxaban.

NPS MedicineWise is also encouraging people to consider some of the other potential risks of taking a newer medicine.

“Rivaroxaban is a fairly new anticoagulant, and even though it has been studied in clinical trials, its full range of long-term side effects and drug interactions is not yet understood. For this reason, some doctors are more likely to prescribe warfarin,” says Dr Binns.

“And rivaroxaban is not a suitable treatment option for everyone. People with artificial heart valves, or people who have recently had major bleeding should not use rivaroxaban and it may not be suitable for people with certain other medical conditions including those that increase their risk of bleeding, and kidney or liver problems.

“If rivaroxaban is not suitable for you, your doctor will prescribe another anti-clotting medicine according to your medical condition and your individual situation.

“But whatever the best treatment option is for you, it is vital that you don’t stop taking your current anticoagulant medicine suddenly without medical advice, as this could put you at risk of blood clots that could cause a stroke.”

Source: http://www.nps.org.au/