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Ignoring the fact that NICE doesn't licence, (it only provides guidance and makes recommendations) they have not yet released their guidelines on dabigatran AFAIK, although the release is imminent. The answer to your question, according to the experts at many meetings this year, is 'No, there is no need to change'. A stable patient, well controlled on warfarin, with no other factors of concern, could and should be allowed to continue the status quo. The key parameter is 'time in therapeutic range' - those patients with a TTR of less than 60% should probably be offered the change, as and when it becomes available. It's also worth noting that a patient on warfarin with a TTR of <40% is at greater risk of a thrombotic stroke than if they weren't on any anticoagulation at all. Robert From: GP-UK [mailto:[log in to unmask]] On Behalf Of James McGlew Sent: 15 November 2011 11:23 To: [log in to unmask] Subject: Re: Dabigatran (Pradaxa(R)) Last week I saw 2 medicine chits coming from a local medical OPD, about patients currently stable on warfarin - saying that we "could consider change to dabigatran as now licensed by NICE". Completely aside from the cost implications, or even that we GPs are nervous of new meds [after glitazones/coxibs] - why would you want to change a patient with therapeutic inr, and no problems? I worry that the drug reps are pushing this very hard among secondary care juniors. James _____ Date: Tue, 15 Nov 2011 11:10:37 +0000 From: [log in to unmask] Subject: Re: Dabigatran (Pradaxa(R)) To: [log in to unmask] There are currently no antidotes available for either dabigatran or rivaroxaban, although you can be sure that the lab guys are burning the midnight oil trying to get something out of the door ASAP. The general feeling right now is that the half-life of these drugs is so short that it doesn't take as long as warfarin might to reduce to a level where surgery could be possible. For a patient who is on warfarin, of course, you can crash-reverse the anticoagulation process and have them on the theatre table inside half an hour - this is not currently possible with dabigatran. Robert From: GP-UK [mailto:[log in to unmask]] On Behalf Of Jel Coward How to fix bleeding in the trauma patient in Emergency Dept?