In October 2011, DTB reviewed the use of dabigatran, the first new oral anticoagulant licensed for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) and one or more defined risk factors.1 We noted that the potential advantages of dabigatran for many patients with AF and the continuing need to provide warfarin therapy for others, provided an important challenge for the NHS. The use of dabigatran has increased significantly in the UK and two other drugs have been licensed for this indication (▼apixaban—Eliquis, Bristol-Myers Squibb/Pfizer; ▼rivaroxaban—Xarelto, Bayer plc).2–6 In addition, published drug safety alerts have highlighted the risk of serious haemorrhage associated with the use of these drugs.7–9 Here we review the evidence for apixaban and rivaroxaban for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation.
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