Evidence Updates are intended to increase awareness of new evidence – they do not replace current NICE guidance and do not provide formal practice recommendations.
NICE CG144 does not include any specific recommendations on the use of rivaroxaban, apixaban, dabigatran and edoxaban. The following are published technology appraisals:
• NICE TA261 recommends rivaroxaban as an option for treating DVT and preventing recurrent DVT and PE after a diagnosis of acute DVT in adults.
• NICE TA 287 recommends rivaroxaban as an option for treating PE and preventing recurrent DVT and PE in adults.
And the following technology appraisals are currently underway or being considered:
• A NICE technology appraisal (ID483) of dabigatran for the treatment and secondary prevention of DVT and/or PE is currently underway.
• A proposed NICE technology appraisal (ID726) of apixaban for the treatment and secondary prevention of DVT and/or PE is being considered.
• A proposed NICE technology appraisal (ID662) of edoxaban for the treatment and secondary prevention of DVT and/or PE is being considered.
Other new evidence which may have a potential impact on NICE CG144 includes the following:
• The routine long-term use of graduated elastic compression stockings does not appear to prevent post-thrombotic syndrome in patients with a first proximal DVT. However, graduated elastic compression stockings are still likely to be useful for symptom relief in patients who have had a DVT.
• In people who have experienced a first unprovoked DVT or PE and completed initial anticoagulation therapy, low-dose aspirin compared with placebo may reduce the risk of VTE and vascular events without increasing the risk of bleeding. Although long-term anticoagulation is the most effective therapy for prevention of VTE recurrence, aspirin may be a potential alternative option in patients who have had an unprovoked VTE and are unable or unwilling to go on long-term anticoagulation therapy.