№ lp_1_2_43320
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Clinical procedure outlining criteria, exclusions, dosing considerations, and governance responsibilities for switching adult patients with non-valvular atrial fibrillation from other direct oral anticoagulants to apixaban within UK clinical practice.
Country:
United Kingdom
Healthcare system:
National Health Service
Clinical area:
Cardiology / Stroke prevention
Condition:
Non-valvular atrial fibrillation
Medication:
Apixaban
Medication class:
Direct oral anticoagulant
Purpose:
Switching existing DOAC therapy to apixaban
Target population:
Adults aged 18 years and over with NVAF
Exclusions:
Patients with contraindications to apixaban or indications other than NVAF
Regulatory references:
NICE recommendations, Summary of Product Characteristics
Type of document:
Clinical procedure
Intended users:
Prescribers and pharmacists
Consultation requirement:
Patient consent and clinician consultation
Monitoring requirements:
Renal function and body weight
Geographical scope:
UK clinical practice
Status of apixaban:
Licensed and available as a generic medicine
Price: 8 / 10 USD
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Canberra Health Services Guideline Apixaban and Rivaroxaban Use in Adults with Severe Kidney Disease
Year:
2021
Region / City:
Canberra, Australia
Topic:
Pharmacology / Kidney Disease
Document Type:
Clinical Guideline
Institution:
Canberra Health Services
Author:
Not specified
Target Audience:
Medical staff and pharmacists
Period of Validity:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified
Year:
Not specified
Region / city:
Not specified
Subject:
Medical referral for Left Atrial Appendage Closure
Document Type:
Medical referral form
Organization / Institution:
Cooper Structural Heart Disease Program
Author:
Not specified
Target Audience:
Medical professionals
Period of validity:
Not specified
Approval Date:
Not specified
Date of changes:
Not specified
Year:
2015
Region / City:
Global
Topic:
Non-Valvular Atrial Fibrillation, Cardiovascular Disease
Document Type:
Report
Organization:
World Heart Federation
Author:
Murphy A, Banerjee A, Breithardt G, Camm J, Commerford P, Freedman B, Gonzales Hermosillo J, Halperin J, Lau C, Perel P, Xavier D, Wood D, Jouven X, Morillo C
Target Audience:
Health professionals, policy makers, public health authorities
Period of Action:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Note:
Year
Year:
Not specified
Region / city:
Not specified
Subject:
Medical referral for Left Atrial Appendage Closure
Document Type:
Medical referral form
Organization / Institution:
Cooper Structural Heart Disease Program
Author:
Not specified
Target Audience:
Medical professionals
Period of validity:
Not specified
Approval Date:
Not specified
Date of changes:
Not specified
Year:
2022
Region / City:
Liverpool, United Kingdom
Subject:
Atrial fibrillation, stroke, smart wearables
Document type:
Research study
Organization / Institution:
University of Liverpool
Authors:
Stephanie L. Harrison, Benjamin J. R. Buckley, Yalin Zheng, Andrew Hill, Thant Hlaing, Ruth Davies, Yutao Guo, Deirdre A. Lane, Gregory Y. H. Lip, Liverpool-Huawei Stroke Study Investigators
Target audience:
Medical researchers, healthcare professionals, cardiologists
Period of validity:
2022-ongoing
Approval date:
30/05/2022
Study ID:
ISRCTN30693819
Year:
2022
Region / city:
England
Theme:
Atrial fibrillation, Anticoagulation, Healthcare indicators
Document type:
Consultation report
Organization / institution:
NHS England, NICE
Author:
NHS England
Target audience:
Healthcare professionals, policy makers
Period of validity:
Ongoing development
Approval date:
N/A
Modification date:
N/A
Year:
2022
Region / city:
England
Topic:
Atrial fibrillation, anticoagulation therapy
Document type:
Indicator guidance
Organization / institution:
NICE
Author:
NICE
Target audience:
Healthcare professionals, general practitioners
Validity period:
Until November 2025
Approval date:
November 2022
Date of changes:
N/A
Source guidance:
NICE’s guideline on atrial fibrillation (2021) recommendations 1.6.3 and 1.6.5
Specification:
CVD-05 indicator, Impact and Investment Fund 2022/23
Exclusions:
People with resolved atrial fibrillation, valvular atrial fibrillation, recorded antiphospholipid syndrome
Note:
Contextual description
Year:
2020
Region / City:
Not specified
Topic:
Stroke risk assessment in Atrial Fibrillation patients
Document Type:
Research Supplementary File
Institution:
Not specified
Author:
Not specified
Target Audience:
Medical professionals, researchers
Period of validity:
Not specified
Approval Date:
Not specified
Date of modifications:
Not specified
Acronym:
ABBRUPT
Organ / Institution:
University of Birmingham
Unit:
Birmingham Clinical Trials Unit (BCTU)
Trial Office:
ABBRUPT Trial Office
Country:
United Kingdom
Regulatory Framework:
UK Data Protection Regulations
Policy Framework:
UK Policy Framework for Health and Social Care Research
Trial Design:
Pragmatic open-label interventional multi-centre two-arm randomised controlled trial with internal pilot and economic evaluation
Objectives:
To compare clinical and cost effectiveness of beta blockers versus amiodarone for new onset atrial fibrillation in intensive care and to conduct cost-effectiveness and cost-utility analyses at 90-day follow-up
Target Population:
Patients aged 16 years and over in intensive care units with new onset atrial fibrillation
Sample Size:
2560 patients
Setting:
At least 60 intensive care units across the UK
Interventions:
Amiodarone versus beta blockers (including bisoprolol, metoprolol, esmolol, propranolol, atenolol, labetalol, carvedilol, landiolol)
Primary Outcome:
90-day mortality
Secondary Outcomes:
Clinical and economic outcomes including ICU and hospital measures
Eligibility Criteria:
Defined inclusion and exclusion criteria for patients with new onset atrial fibrillation in ICU
Data Management:
Contact details retained indefinitely on a BCTU database and subject to written request under UK Data Protection Regulations
Oversight Requirements:
Approval required from relevant Trust or Health Board Management prior to patient consent
Consent Requirements:
Written informed consent and participant information sheet on Trust/Health Board headed paper
Local Governance:
Compliance with Good Clinical Practice and UK Policy Framework for Health and Social Care Research
Year:
2016
Region / city:
United States
Topic:
Clinical performance measures for atrial fibrillation
Document type:
Report
Organization:
American Heart Association
Author:
Steve Dentel, William Lewis
Target audience:
Healthcare professionals, clinicians, cardiologists
Period of validity:
2016
Approval date:
Not specified
Date of revisions:
Not specified
Year:
2015
Region / City:
Global
Topic:
Non-Valvular Atrial Fibrillation, Cardiovascular Disease
Document Type:
Report
Organization:
World Heart Federation
Author:
Murphy A, Banerjee A, Breithardt G, Camm J, Commerford P, Freedman B, Gonzales Hermosillo J, Halperin J, Lau C, Perel P, Xavier D, Wood D, Jouven X, Morillo C
Target Audience:
Health professionals, policy makers, public health authorities
Period of Action:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2026
Region / City:
Not specified
Topic:
Cardiology, Obesity, Atrial Fibrillation
Document Type:
Research Study
Institution:
Not specified
Author:
Not specified
Target Audience:
Cardiologists, medical researchers, healthcare professionals
Study Population:
Morbidly obese patients with BMI ≥35 kg/m² undergoing AF catheter ablation
Sample Size:
217 patients
Methods:
Retrospective observational study
Primary Outcome:
Composite of recurrent atrial arrhythmias and cardiovascular hospitalizations
Risk Factors Analyzed:
BMI fluctuations, blood pressure, obstructive sleep apnea, hyperlipidemia, tobacco use, alcohol use, diabetes mellitus with HbA1c >6.5%
Follow-up Period:
Mean 2.9 years after ablation
Key Findings:
Only HbA1c >6.5% independently predicted primary outcome; timing of ablation did not affect outcomes
Conclusion:
Optimizing glycemic control is crucial for reducing recurrent atrial arrhythmias and cardiovascular hospitalizations in morbidly obese patients undergoing AF ablation
Year:
2020–2021
Region:
Newham, UK
Theme:
Community health services, Atrial fibrillation, Anticoagulant therapy
Document Type:
Service specification
Organization:
Newham Clinical Commissioning Group (CCG)
Author:
NHS commissioning team
Target audience:
Healthcare providers, community pharmacists, GPs
Period of validity:
1st April 2020 – 31st March 2021
Review date:
Not specified
Scope:
Initiation and counselling of oral anticoagulants for patients with atrial fibrillation
Clinical guidelines referenced:
NICE Guidelines, British Committees of Haematology (BCSH), National Patient Safety Agency (NPSA)
Population covered:
Patients registered with Newham GP practices
Service objectives:
Improve access, patient education, reduce inequalities, enhance quality of care, maintain communication across health professionals
Care pathway:
Acute specialist team initiates therapy, community service manages ongoing care, includes counselling, monitoring, and documentation
Exclusion criteria:
Patients deemed clinically unsafe for outpatient management
Year:
Not specified
Field:
Perioperative medicine
Subject:
New-onset atrial fibrillation and catecholamine vasopressor use after non-cardiac surgery
Document type:
Supplementary tables and figures of a clinical research study
Study population:
Surgical patients receiving catecholamine vasopressors and comparator patients
Sample size:
6000 patients
Comparison groups:
Vasopressor group and comparator group
Variables analyzed:
Demographics, comorbidities, medications, types of surgery, postoperative outcomes
Statistical methods:
Univariate and multivariate logistic regression; propensity score matching; subgroup and interaction analyses
Medical conditions examined:
Atrial fibrillation, stroke, myocardial infarction, heart failure, acute kidney injury
Drugs examined:
Norepinephrine, epinephrine, dopamine, metaraminol
Clinical setting:
Non-cardiac surgery
Abbreviations defined:
AF, CCB, ARB, ACEI, MI, HF, AKI
Year:
2026
Region / city:
International multicenter
Topic:
Cardiology, Hematology
Document type:
Supplementary tables and figures
Institution:
GARFIELD-AF and ORBIT-AF study groups
Authors:
Multi-center registry investigators
Target audience:
Clinicians, researchers
Study period:
2 years follow-up
Data collection:
Patient registries
Patient population:
Adults with atrial fibrillation receiving oral anticoagulants
Measured outcomes:
Incidence of intracranial hemorrhage, baseline characteristics, treatment type, comorbidities, vital signs
Data analysis:
Risk factor association with intracranial hemorrhage
Treatment types:
NOAC, VKA, concomitant antiplatelet therapy
Year:
2026
Region / Country:
Multinational
Subject:
Atrial fibrillation treatment strategies
Document type:
Research supplement
Institution:
Clinical research consortium
Population:
Patients with atrial fibrillation
Sample size:
63,525
Variables analyzed:
Demographics, comorbidities, baseline medications, AF type, clinical outcomes
Treatment strategies:
Rate control, Rhythm control
Follow-up period:
2 years
Outcomes measured:
All-cause mortality, cardiovascular mortality, non-haemorrhagic stroke/SE, major bleeding, heart failure
Statistical methods:
Propensity score weighting, overlap-weighted Cox model
Sensitivity analyses:
Exclusion of new-onset AF, exclusion of primary care diagnoses
Year:
2023
Field:
Cardiac electrophysiology
Document type:
Research supplementary material
Methods:
MATLAB and computational simulations
Models:
Aliev-Panfilov, Courtemanche-Ramirez-Nattel
Authors:
Ravinutala, Aliev, Panfilov, Courtemanche, Aguilar et al.
Audience:
Researchers in cardiac modeling and arrhythmia studies
Data:
Simulated phase singularity formation and lifetimes, parameter distributions, histograms, and probability calculations
Purpose:
Illustration of the inspection paradox effect in rotor lifetime analysis
Software:
MATLAB R2018 and Python-adapted code
Simulation details:
Rectangular 200x200 grids, diffusion coefficient 0.2, varied μ1 and μ2 parameters
Reference studies:
Ten Tusscher and Panfilov 2003, Aliev and Panfilov 1996, Courtemanche et al. 1998, Aguilar et al. 2017