A busy week for the National Institute of Health and Clinical Excellence has seen the UK’s health watchdog recommend Boehringer Ingelheim’s oral anticoagulant Pradaxa.

The decision means that Pradaxa (dabigatran etexilate) will be available on the National Health Service as an option for the primary prevention of venous thrombembolic events in adults who have undergone elective total hip or total knee replacement surgery. It comes after NICE published a ‘final appraisal determination’ which gives a draft recommendation for the drug in July and Pradaxa is the first oral anticoagulant for preventing VTE to be licensed in the UK for more than 50 years.

Boehringer said the positive NICE appraisal coincides with the recent publication of a government VTE risk assessment tool recommended for all patients admitted to hospital in England by the Department of Health. The firm said that routine risk assessment “is a fundamental step in ensuring patients at risk of developing VTE receive the appropriate therapy and management”.

VTE is the most common cause of preventable hospital death in the UK and up to 32,000 patients die every year after developing blood clots in hospital. A recent analysis by the All-Party Parliamentary Thrombosis Group revealed that over 10,700 UK hospital patients may have died from blood clots in just seven months during 2007 as a result of clinical guidelines not being implemented.

The charity AntiCoagulation Europe welcomed NICE's recommendation and chief executive Eve Knight said “it is appalling that patients are still developing and dying from VTE, which could be prevented by risk assessing every patient on admission to hospital and giving preventative treatment where needed”. Until now, anticoagulant therapy to prevent blood clots after major orthopaedic surgery has generally required administration by injection, but now Pradaxa, a once-daily oral therapy, “will enhance the treatment options available”, she said

The number of people who die from developing blood clots exceed the combined total deaths from breast cancer, AIDS and road traffic accidents and equate to more than 25 times the annual deaths from MRSA. However, Boehringer notes that the NHS spends ten times as much on MRSA prevention than VTE and while the latter costs £640 million every year to manage, 60%-80% of this could be saved through preventative measures.