Inclusion in the World Health Organization Model List of Essential Medicines of Non-Vitamin K Anticoagulants for Treatment of Non-Valvular Atrial Fibrillation: A Step Towards Reducing the Burden of Cardiovascular Morbidity and Mortality
Ezequiel J. Zaidel,
Xinyi Leng,
Abiodun Moshood Adeoye,
Ferdous Hakim,
Biraj Karmacharya,
Asim Katbeh,
Lis Neubeck,
Stephanie Partridge,
Pablo Perel,
Mark D. Huffman,
Mariachiara Di Cesare
Affiliations
Ezequiel J. Zaidel
Cardiology Department, Sanatorio Güemes, and Pharmacology Department, School of Medicine, University of Buenos Aires
Xinyi Leng
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
Abiodun Moshood Adeoye
Cardiovascular Unit, Department of Medicine, University College Hospital, Ibadan/College of Medicine, University of Ibadan, Ibadan; Cardiovascular Genetics and Genomic Research Unit, Institute of Cardiovascular Diseases, Faculty of Clinical Sciences, College of Medicine, University of Ibadan
Ferdous Hakim
Research and Publication Unit, World Health Organization
Biraj Karmacharya
Department of Public Health, Public Health and Community Programs, Kathmandu University School of Medical Sciences
Asim Katbeh
International PhD Programme in Cardiovascular Pathophysiology and Therapeutics, CardioPaTh
Lis Neubeck
School of Health and Social Care, Edinburgh Napier University, GB; The University of Sydney Susan Wakil School for Nursing and Midwifery, Charles Perkins Centre, Sydney
Stephanie Partridge
Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
Pablo Perel
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine
Mark D. Huffman
Northwestern University Feinberg School of Medicine, Departments of Preventive Medicine and Medicine and Center for Global Cardiovascular Health, Chicago, Illinois, US; The George Institute for Global Health, University of New South Wales, Sydney
Mariachiara Di Cesare
Department of Natural Science, School of Science and Technology, Middlesex University London
Non-vitamin K antagonist oral anticoagulants (NOACs) represent a paradigm shift in the treatment of non-valvular atrial fibrillation (AF) with major practice guidelines around the world recommending NOACs over vitamin K antagonist oral anticoagulants for initial treatment of AF for stroke prevention. Here we describe the evidence collated and the process followed for the successful inclusion of NOACs into the 21st WHO Model List of Essential Medicines (EML). Individual NOACs have been reported to be non-inferior or superior to warfarin in preventing stroke and systemic embolism in eligible AF patients with a reduction in the risk of stroke and systemic embolism and a lower risk of major bleeding in patients with non-valvular AF compared with warfarin in both RCTs and real-world data. The successful inclusion of NOACs in the WHO EML is an important step forward in the global fight against cardiovascular morbidity and mortality, especially in low- and middle-income countries, where the burden of disease is high and limited access to diagnosis and treatment translates into a higher burden of morbidity, mortality, and economic costs.
