NICE has issued a fast-tracked Final Appraisal Determination (FAD) recommending the oral anticoagulant Eliquis (apixaban) as an option for preventing stroke and systemic embolism, in patients with non-valvular atrial fibrillation (AF) with one or more risk factors. The NICE appraisal committee concluded that apixaban was cost effective and more clinically effective for reducing stroke and systemic embolism; and resulted in fewer bleeds than warfarin. The Single Technology Appraisal (STA) for apixaban has been fast-tracked straight to FAD, bypassing the need for draft guidance for consultation. Apixaban is the only oral novel anticoagulant (NOAC) so far appraised by NICE in this indication to go straight to FAD. The FAD forms the basis of the final guidance to the NHS in England and Wales and, pending no change, is expected in February, 2013. Once the final guidance is published the NHS will be legally obliged to implement it within 90 days.