Weigh risks and benefits of old and new oral anticoagulants

29 April 2013

NPS MedicineWise is urging health professionals to weigh the risks and benefits of oral anticoagulant therapies in people with non-valvular atrial fibulation (AF) following the Pharmaceutical Benefits Advisory Committee (PBAC) recommendation that newer oral anticoagulants (NOACs) be listed on the Pharmaceutical Benefits Scheme (PBS).

Following an extensive review of NOACs over the past two years, PBAC has now recommended that dabigatran (Praxada), rivaroxaban (Xarelto), and apixaban (Eliquis) be subsidised under the scheme for stroke prevention in non-valvular AF.

In light of the recommendations, NPS MedicineWise CEO, Dr Lynn Weekes, said GPs must consider the safety and efficacy of newer therapies in context with warfarin – a medicine that has been the mainstay of anticoagulation therapy in clinical practice for many years. 

“There is a clear need to establish good anticoagulant practice in Australia and a decision to subsidise newer anticoagulant therapies under the PBS would present GPs with a choice which needs to be weighed carefully against the alternatives,” says Dr Weekes. 

“Doctors who are prescribing and monitoring patients requiring anticoagulant therapy need to weigh the risks and benefits of newer medicines and carefully consider the safety issues involved in switching therapies.”

Dr Weekes said that while the subsidy of newer oral anticoagulants represents a greater choice for GPs and their patients, evidence suggests that people with non-valvular AF whose anticoagulation is well controlled using warfarin may not benefit clinically from switching to a newer oral anticoagulant.

“As there are no readily available and validated tests for measuring the anticoagulant effect of the newer oral anticoagulants, routine clinical monitoring of all patients on anticoagulant therapy is still essential, regardless of which type they are using.

“And while the new oral anticoagulants don’t require monitoring with a blood test, there is significant risk for the patient because there is no readily-available antidote to reverse bleeding should it occur when using these newer agents.”

In February this year, NPS MedicineWise launched a new educational program for health professionals to provide clarity around the newer oral anticoagulants and their place in therapy. The program supports GPs in their clinicial decision-making and assists pharmacist to feel more confident in their role when it comes to advising and educating patients requiring anticoagulant therapy. 

The program – Achieving Good Anticoagulant Practice –  is designed to ensure that people understand the potential benefits and side effects of the full range of oral anticoagulant therapies available. 

“The recommendation to make newer anticoagulants more affordable in Australia provides a great opportunity for GPs to review treatment for patients at risk of thromboembolism and evaluate the risk and benefits of the various treatment options available,” says Dr Weekes. 

“Our new program for health professionals is designed to cut through the confusion and it is our goal that the program will provide reassurance and accurate, evidence-based information about using anticoagulants safely and effectively.”

For more information about the new program, resources and regular program updates visit www.nps.org.au/anticoagulants     

New decision support tools for oral anticoagulants, including an anticoagulant safety checklist, switching oral anticoagulants, dose adjustments for newer anticoagulants, and a decision algorithm, are also now available at www.nps.org.au/anticoagulant-decision-tools 


Independent, evidence-based and not-for-profit, NPS MedicineWise enables better decisions about medicines and medical tests. We are funded by the Australian Government Department of Health and Ageing.

Media enquiries: Stephanie Childs on 02 8217 8667, 0419 618 365 or schilds@nps.org.au