Review of TA249; Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation, TA256; Rivaroxaban for the prevention of stroke in atrial fibrillation and Apixaban for preventing stroke and systemic embolism in people with nonvalvular atrial fibrillation (publication anticipated in February 2013)

Proposal to incorporate the review into a Clinical Guideline

The planned date for the consideration of a review of TA249 and TA256 is October.  The FAD for apixaban states that "the guidance on this technology will be considered for review alongside the related technology appraisals TA249 and TA256".

These three pieces of guidance overlap with the ongoing update of CG36; Atrial fibrillation, and the consideration of a review of has therefore been expedited to coincide with this.

There is no new evidence that is likely to have a material effect on the current recommendations in TA249, TA256, or the draft guidance for apixaban.  All three drugs are recommended ‘as options’ for the prevention of stroke in atrial fibrillation, and this would be unlikely to change in the event of an update of the guidance.  There may however be other reasons for clinicians to choose one drug over the others, and these reasons could stem from the contextualisation within a clinical guideline.

As a result, we believe that TA249, TA256 and the final guidance for apixaban should be incorporated into the ongoing update of CG36.  The technology appraisals will be moved to the static list and will remain extant when the guideline is published. This has the consequence of preserving the funding direction.

In order to be completely confident that this is appropriate, we are asking all relevant consultees and commentators, to inform us of any evidence which would suggest that a review would be beneficial.  Please see appendix A for a full list of the organisations we have contacted. 

February 2013