The Surrey Heartlands Integrated Care System Area Prescribing Committee agreed the updated Surrey Heartlands Oral Anticoagulant selection tool in Atrial Fibrillation.

Apixaban is now the recommended 1st-line DOAC in accordance with the updated NHSE Commissioning Recommendations.

Apixaban is available generically and is the most cost-effective DOAC.

Refer to the Oral Anticoagulation Selection Tool for full guidance.

The Surrey Heartlands ICS Area Prescribing Committee have agreed the use of an ORBIT-bleed risk scoring tool when considering or reviewing anticoagulant treatment in Atrial Fibrillation (AF).

The Surrey & North West Sussex Area Prescribing Committee have agreed the updated guidance on calculating creatinine clearance for DOACs. See below. The DOAC selection tool updated in October 2019, remains unchanged.

A clinical trial has shown an increased risk of recurrent thrombotic events associated with rivaroxaban compared with warfarin, in patients with antiphospholipid syndrome and a history of thrombosis. Other direct-acting oral anticoagulants (DOACs) may be associated with a similarly increased risk.
Please see Thrombosis risk safety alert information below

The September APC also agreed the use of a DOAC patient information leaflet and a counselling checklist for use by healthcare professionals when patients commence DOAC therapy - see documents below