Greater Glasgow and Clyde Medicines

Restrictions:

Prevention of stroke in atrial fibrillation

Use for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation and with one or more risk factors is restricted to:

• those currently receiving warfarin who have poor INR control despite evidence that they are complying
• patients with allergy or intolerable side effects from coumarin anticoagulants
• patients for whom warfarin has been clinically excluded as a therapeutic option but anticoagulation is deemed safe and appropriate

Risk factors may include: congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischaemic attack. 

Further advice can be accessed via the NHSGGC Atrial Fibrillation guideline and the Prescribing Resources section of this website

Treatment of VTE

• Rivaroxaban for the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) and prevention of further DVT and PE is restricted to use in patients requiring anticoagulation where the intended duration of treatment is 3 to 6 months and in whom apixaban is deemed unsuitable.

VTE prophylaxis in orthopaedic surgery

• The use in VTE prophylaxis in orthopaedic surgery is restricted to specialist use only in accordance with local protocol.

Use in combination with aspirin in Coronary Artery Disease

• Rivaroxaban co-administered with aspirin for the prevention of artherothrombotic events in adults is restricted to initiation by, or on the advice of a consultant only in patients with stable coronary artery disease that do not require dual antiplatelet therapy.

It should be noted that use of rivaroxaban in combination with aspirin for the prevention of atherothrombotic events in patients with peripheral artery disease (PAD) alone was not considered by SMC and the use in this setting is non-Formulary.

Prescribing Notes:

The following indications are not recommended for use by the SMC and are non-Formulary:

• Acute Coronary Syndrome: The use of rivaroxaban for the prevention of atherothrombotic events in adult patients after an acute coronary syndrome (ACS) with elevated cardiac biomarkers is not recommended for use within NHS Scotland and is therefore non-Formulary.
• Prevention of atherothrombotic events: use of rivaroxaban in combination with aspirin for the in patients with peripheral artery disease (PAD) alone was not considered by SMC and the use in this setting is non-Formulary.
• Atrial fibrillation: rivaroxaban is not included in the Formulary for use in newly diagnosed patients.

BNF Link