16 April 2015

NICE Recommends Rivaroxaban to Prevent Blood Clots in Patients Who Have Had a Heart Attack

Rivaroxaban (Xarelto), in combination with clopidogrel and aspirin, or with aspirin alone, can now be used as an option for preventing blood clots in people who have had an acute coronary syndrome, following latest guidance.

People who have had a heart attack are at increased risk of further complications. In 2009/10 admissions for heart attacks in England, with 28,000 subsequent heart attacks.

Given as a tablet, rivaroxaban helps to maintain blood flow to the heart muscle to prevent further damage to the heart.

In latest guidance, NICE recommends that rivaroxaban can be used in combination with aspirin plus clopidogrel, or aspirin alone, for preventing atherothrombotic events in people who have had an acute coronary syndrome with elevated biomarkers.

The guidance recommends that before starting treatment, doctors should carry out a careful assessment of a person’s bleeding risk. This is because rivaroxaban is associated with a higher risk of causing bleeding than clopidogrel in combination with aspirin or aspirin alone,

The decision to start treatment should be made after an informed discussion between the doctor and patient about the benefits and risks of rivaroxaban.

Careful consideration should also be given to whether treatment is continued beyond 12 months, as there is limited experience of treatment with rivaroxaban up to 24 months. 

Professor Carole Longson, NICE Health Technology Evaluation Centre Director, said: “Based on the evidence considered, the independent Appraisal Committee concluded that rivaroxaban, in combination with aspirin plus clopidogrel or with aspirin alone, was more effective than aspirin plus clopidogrel or aspirin alone for preventing further cardiovascular deaths and heart attacks in people with acute coronary syndrome and raised cardiac biomarkers.

"The Committee therefore recommended rivaroxaban as a cost-effective use of NHS resources."