NICE has issued final guidance recommending the new oral anticoagulant, Pradaxa® (dabigatran etexilate) as a cost-effective option for the prevention of stroke and systemic embolism in adult patients with nonvalvular atrial fibrillation (AF) and one or more risk factors. This decision means dabigatran must now be made available for use by the NHS and that patients have the right to receive it if clinicians deem it clinically appropriate. It is estimated that 1.2 million people are diagnosed with AF in the UK, of which 77% are eligible for treatment with an anticoagulant. The use of dabigatran 150mg twice daily has the potential to prevent 530 more strokes per 100,000 patients every year compared to wafarin, the current standard of care. If all eligible patients were to receive dabigatran 150mg twice daily instead of warfarin, this could mean preventing up to 5,000 strokes, saving the NHS up to £59 million in the first year. Stroke (of which an estimated 15% are caused by AF) is one of the top three causes of death and the largest cause of adult disability in England. Martin Cowie, Professor of Cardiology, Royal Brompton Hospital, London, said: “The NHS needs to act to optimise the diagnosis and treatment of atrial fibrillation: a very common reason for strokes in the UK. Many patients and doctors will welcome today’s news that an effective new treatment to reduce the risk of such strokes has been approved by NICE. We have waited for more than 50 years for an alternative to warfarin, and I am delighted that at last we have another option to offer to patients who might benefit.” A recent study published in the BMJ shows that stroke prevention in patients with AF is not optimally managed. Whilst many patients are treated with warfarin, a significant proportion are not well controlled within the target INR range, with others receiving inadequate antiplatelet treatment such as aspirin, and up to 30% are given no treatment at all. This represents a large unmet need and treating these patients with dabigatran has the potential to significantly reduce stroke risk where existing treatment is not appropriate or treatment is not being offered.