NHS Bristol, North Somerset and South Gloucestershire are reviewing all patients receiving DOACs. They have asked all GP teams to review the prescribing of Edoxaban in line with NHS England recommendations. Edoxaban previously offered the NHS good value for money compared to other DOACs because of a contract between the manufacturers and the NHS. Since 2024 both Apixaban and Rivaroxaban have become available as unbranded medicines and so the price has dropped considerably, and they are now the first choice DOACs for use in our area.
We are switching patients on repeat from once daily Edoxaban (Lixiana) costing around £600 each year per person to either twice daily Apixaban or a once daily Rivaroxaban costing around £45 per year.
Side effects
As with all medication there is a risk of developing side effects. The most common side effect of all DOACs is bleeding, including bruising and nose bleeds. For more information, see the manufacturer’s patient information leaflets Apixaban is slightly better for risk of bleeding compared to Rivaroxaban (1.4 bleeds per 100 patient years vs 1.9 bleeds per 100 patient years). Some patients prefer Rivaroxaban due to the once-a-day dosing vs twice a day with Apixaban. Below is the relative risk of having a GI bleed for each medication:
Will I need regular blood tests?
The same monitoring as Edoxaban will be required, which involves checking your kidney
function and weight at least once a year.
We need to carry out blood tests to ensure you are on the correct strength of Rivaroxaban or Apixaban. We additionally need your weight to make sure you’re on the correct strength of Apixaban, so it is important that this value is accurate.
We will ask for more frequent monitoring if you are older (over 75), have other medical conditions or have a lower kidney function.
Switching from Edoxaban
Use up any existing supply of Edoxaban. Take your last Edoxaban as usual, then take the first Apixaban or Rivaroxaban when the next dose of the Edoxaban is due.
Apixaban is taken twice a day with or without food. Rivaroxaban is taken once daily and
should be with food. The precise time of day is not important, but it is important to try to take DOACs every day at a similar time of day.
Can Apixaban or Rivaroxaban go into a patient compliance device?
There are no known issues with using Apixaban or Rivaroxaban in a compliance device.
Further information
Always read the patient information leaflet that comes with your medicine.
If you have any questions about this change in medicine or would like to discuss it further, please speak to your GP or practice pharmacist, or your local community pharmacist.
Please update and carry with you the “Alert Card” supplied with your new medication
and discard your old card.