New anticoagulant offers no benefit if stable on warfarin

In its latest advice to prescribers the NPS said there was no clinical advantage in changing drugs if a patient’s INR was within the therapeutic range of 2.0 to 3.0 60% of the time.

“Be cautious when switching between warfarin and rivaroxaban. There is limited evidence on switching from or to other anticoagulants,” it said in an NPS Radar bulletin.

It warned that patients with a history of poor compliance may be unsuitable for the drug because its short half-life could result in an increased risk of stroke if doses were missed.

“In these circumstances warfarin remains preferable as it has a longer half-life and compliance can be monitored,” the NPS said.

Rivaroxaban was an alternative to consider for people who, for reasons other than compliance, could not be controlled on warfarin, it added.

The NPS acknowledged the drug had demonstrated efficacy in stoke prevention in people with non-valvular AF