England’s National Health Service (NHS) has hailed the impact of direct oral anticoagulants (DOACs), citing that thousands of lives have been saved following the drugs’ expanded use to more patients at higher risk of stroke.
Since January 2022, around 460,000 more people in England who live with atrial fibrillation started receiving DOAC therapy, according to the NHS.
Approximately 1.5 million people in England are estimated to live with atrial fibrillation – a heart rhythm disorder that causes one in five strokes.
The expanded use of DOACs to 90% of higher-risk stroke patients has prevented an estimated 17,000 strokes and 4,000 deaths, based on the 2 November NHS press release.
In April 2021, the National Institute for Health and Care Excellence (NICE) recommended four DOACs for the management of stroke risk. NICE guidance stated that DOACs are more effective for the prevention of atrial fibrillation-related stroke than other types of anticoagulants such as the commonly prescribed warfarin.
The recommended DOACs include Bristol Myers Squibb and Pfizer’s Eliquis (apixaban), and Boehringer Ingelheim’s Pradaxa (dabigatran). Additionally, the organisation also recommended the use of Bayer’s Xarelto (rivaroxaban) and Daiichi Sankyo’s Lixiana (edoxaban).
In January 2022, NHS commissioning guidance recommended the use of Lixiana as a preferred option for prescribers due to it being the most cost-effective treatment out of the four DOACs.
DOACs inhibit clotting factors such as thrombin or Factor Xa, thereby decreasing the risk of ischemic stroke – the more common type of stroke caused by a blood clot in an artery in the brain.
The NHS said a series of deals struck with the drug manufacturers in 2021 meant the four DOACs could be used more widely. In addition, the NHS has also invested £45m ($55.03) in helping to launch schemes to diagnose and treat atrial fibrillation patients, such as early testing with a handheld device.
Stroke Association policy and research associate director Dr Maeva May said: “It’s fantastic news that oral anticoagulants have helped to prevent so many strokes over the last two years. The majority of atrial fibrillation-related strokes are preventable with the right medication.
"Managing atrial fibrillation correctly improves people’s quality of life and is cost-effective for the system. Both atrial fibrillation and other stroke prevention measures must continue to be prioritised regionally and nationally.”
