Remember to weigh up risks and benefits of new PBS-listed anticoagulants

1 September 2013

NPS MedicineWise is reiterating safety messages around the newer anticoagulants dabigatran (Pradaxa) and apixaban (Eliquis) following their PBS listing for preventing stroke on 1 September 2013 – and again for rivaxabaran (Xarelto) which was PBS listed in August for the same purpose.

These medicines will be subsidised by the Pharmaceutical Benefits Scheme (PBS) for preventing stroke in people with non-valvular atrial fibrillation, and may offer alternatives for some people.

However, NPS MedicineWise clinical adviser Dr Andrew Boyden emphasises that there are risks associated with taking these medicines and that health professionals should seek up to date information to help inform conversations with patients about their options.

“We’re encouraging consumers who are already taking an oral anticoagulant to prevent stroke to talk to their doctor if they want to know more about the newer oral anticoagulants because — like all medicines — there are risks as well as benefits involved in taking them, but this is particularly important in the case of anticoagulants,” he says.

To assist health professionals in navigating the new options, NPS MedicineWise has developed a new decision tool about switching oral anticoagulants which covers recommended dosing and timing for patients switching from warfarin, to warfarin, or from a newer oral anticoagulant to an alternative newer oral anticoagulant.

Dr Boyden says that one of the main principles of safe switching with anticoagulants is to ensure continuous, adequate anticoagulation while minimising bleeding risk.

Some tips for prescribers in the decision support tool include:

  • remember that although all newer anticoagulants can contribute to an elevated INR, the INR is not a measure of their anticoagulant effect;
  • make sure clear instructions are provided to the patient to avoid missed or double doses during switching;
  • advise patients to return any oral anticoagulant medicine no longer required to their doctor or pharmacist for safe disposal when switching is completed.

NPS MedicineWise is also urging all health professionals to ensure patients are aware of the risks of the newer oral anticoagulants, including that unlike warfarin, if bleeding occurs while taking one of the newer anticoagulants, there is currently no way to reverse it quickly.

“Consumers are being encouraged to talk to their doctor to be educated on the signs of bleeding that they should be aware of and when they should see their doctor or go to the hospital emergency department,” says Dr Boyden.

“Health professionals can help people understand that although those taking the newer oral anticoagulants don’t need regular INR blood tests, there is currently no equivalent test to monitor how well these medicines are working, and that regular clinical monitoring is still necessary.

“And importantly, we’re urging people not to stop taking their current anticoagulant suddenly without medical advice, as this could put them at risk of stroke.”

To help health professionals and consumers find more information and make informed decisions about the newer anticoagulant medicines available on the PBS, NPS MedicineWise has published information on its website at This information includes recent NPS RADAR articles on dabigatran, rivaroxaban and apixaban, resources from the current NPS MedicineWise educational program, as well as decision support tools to assist good anticoagulant practice.


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