new anti-clotting drugs and NHS funding?

Why would a person need to go on these newfangled medicines if their AF is being managed perfectly well with Aspirin I mean if things worsened they could replace Aspirin with or add Clopidogrel

These medicines have been approved by NICE as options for stroke prevention for patients with AF and who meet other criteria (e.g age, and other conditions such as high blood pressure or diabetes). Although aspirin is seen as a "safer" option than warfarin and other anticoagulants, the fact remains that aspirin is nowhere near as good as the alternatives for stroke prevention, and many more strokes would be prevented using warfarin etc. Aspirin should really only be used where a patient is unable to tolerate an anticoagulant, refuses one or has a clinical reason not to be prescribed one.

The newer anticoags are not going to have as much safety data because of the fact that they're new and warfarin has decades of experience backing its use. As regards to expense, although warfarin tablets are cheaper, there is the expense of the monitoring, blood tests etc which need to be taken into account. The decision to use warfarin or a newer agent needs to be made together between a patient and GP.

Tarun (hospital pharmacist)

Hi House - i had thought the same until new guidelines from the European Society of Cardiology came out saying that for patients with certain Chads score (above 1) its best to use the newer anticoagulants, then warfarin and aspirin as a last resort. The QoF has also changed to reflect the newer options for patients but uptake of these new medicines is really slow in certain regions - faster in others and i;m trying to understand why. Fully realise some patients might prefer warfarin and feel more comfortable on aspirin, but if they did want the newer drugs and didn't like lengthy trips to INR clinics then it should be an option. Just trying to find out if this is the case or not and think Tarun's comment are right.

It's a CHADS score of 1 or over if there are other risk factors,, it says the patients preference should be 'considered' According to this CHADS score I'd be a 3-4 Nah I don't need Warfarin I'm already on Clopidogrel and I bleed for days from simple paper cuts

Hi tori

Uptake is variable across the country but this in part reflects the fact that these drugs are almost always being started in hospital, where we can at least keep an eye on patients as they start treatment. GP's then will continue prescribing in primary care. If some consultants personally do not want to use them, the GP's in turn will be reluctant to prescribe something like this. Over time as the drug is prescribed more frequently, GP's will become more familiar with their use and more willing to prescribe them. As House says the CHADS score (or CHADS2VASC2 which should be used instead) is important but there also needs to be an assessment of bleeding risk (there is another scoring system called HASBLED). If this is deemed to be significant then doctors may be more reluctant to prescribe an anticoagulant.

Yes Tarun is right,, as I was going to say (but forgot) Consultants need to prescribe these newer medicines (and as Tarun said) then the GPs will go along with it