Direct Oral Anticoagulants (DOACs) not prescribed as rivaroxaban or apixaban tablets

We divide the combined number of defined daily doses (DDDs) of DOACs that are NOT rivaroxaban or apixaban tablets by the total number of DDDs of all DOACs and then multiply that by 100 to obtain a percentage each month. Rivaroxaban 15mg/20mg treatment initiation packs have been excluded from the measure as it is not possible to allocate a defined daily dose for comparison.

In September 2024 the NHS in England released updated commissioning recommendations for DOACs, which state:

For patients commencing treatment for atrial fibrillation (AF): subject to the criteria specified in the relevant NICE technology appraisal guidance, clinicians should use the best value DOAC that is clinically appropriate for the patient. Apixaban and rivaroxaban (prescribed generically) are currently the joint best value DOACs.

The NHS England National Medicines Optimisation Opportunities for 2024/25 also identify using best value direct-acting oral anticoagulants as an area for improvement.

Please note: OpenPrescribing Hospitals measures have a consistent way of visualising measures, where 'lower is better' and therefore in this case we show the proportion of DOACs which are NOT prescribed as rivaroxaban or apixaban tablets. There are also other oral formulations of DOACs recently introduced onto the market. We do not consider these to be as cost-effective, and they are not considered as first-line in this measure. You can read more about these details and the timeline of the commissioning recommendations in our blog.