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NHS Guidelines: Apixaban to treat Atrial Fibrillation (2024)

NHS Guidelines now recommend apixaban to treat Atrial Fibrillation

As of January 2024, NHS guidance has changed and generic apixaban (blood thinners) are now recommended for treating Atrial Fibrillation. Dr Malik explains more.

Need to knows

  • New guidance was released January 2024
  • Apixaban (blood thinners) are no longer patented and no longer exclusive
  • NHS guidelines now recommend apixaban
  • Apixaban will be much easier to access through the NHS
  • This will lead to improved health outcomes for patients with Atrial Fibrillation (AF)

Apixaban reduces your risk of stroke

If you’ve been diagnosed with Atrial Fibrillation (AF), you’ve got a higher risk of stroke than the general population. Fortunately, blood thinners reduce this risk. Thanks to new guidance, the NHS is now able to recommend and supply the best value generic apixaban to anyone who needs it (whether the AF is undiagnosed or untreated).

Which blood thinner is best?

Apixaban is a generic term and doesn’t refer to a specific name of medication. Your prescribing clinician will use the NICE guidance to determine which blood thinner is best for your condition and individual circumstances.

Here’s the recommendations, in order of best value:

  1. Generic apixaban
  2. Edoxaban (Lixiana®)
  3. Rivaroxaban (Xarelto®)
  4. Dabigatran (Pradaxa®)
  5. Eliquis® (branded apixaban)

Any of these blood thinners (DOACs) are fine to use – you don’t need to change from one to another. However, your GP or pharmacy might suggest switching to apixaban as a cost-saving to the NHS, whilst still being just as effective.

What if I can’t take DOACs?

If you can’t tolerate blood thinners, vitamin K antagonists (such as Warfarin) will be recommended as an alternative.

 Book your consultation with Dr Malik

If you’ve got untreated or undiagnosed Atrial Fibrillation, let Dr Malik help you get the quality of your life back. He’s got decades of experience treating heart conditions and takes a personalised approach that makes you feel taken care of every step of the way.



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Discover Atrial Fibrillation treatment


See the full guidance at: 


Dr Malik helps to shape the future of TAVI valves | LCVC

Dr Malik helps to shape the future of TAVI valves

I was at the LONDON VALVE 2023 recently to help shape the future of TAVI. Here are my main takeaways.

TAVI (transcatheter aortic valve implantation) is becoming the procedure of choice for treating aortic valve stenosis over the age of 70, and one of the main manufacturers, Abbott , managed to get a large number of UK medical professionals into one lecture theatre to discuss the procedure! 

I was impressed with the faculty – the great and good of UK structural heart intervention. We shared ideas, built expertise and collaborated to help improve patient outcomes worldwide.

Key takeaways

  • We discussed what we wanted for the next generation of TAVI valves, including:
    • Less risk of pacing
    • More deliverables
    • Smaller devices
    • More data on durability – can it last more than 10 years?
    • Data comparing this Navitor valve from Abbott with surgery (as the Edwards and Medtronic companies have already done)
  • We all shared our concerns about the increasing NHS waiting lists
  • We discussed mitral valve repair also – this is even further behind in the UK thanTAVI!

I recently did 8 TAVI procedures on the NHS in just one week – and still, the list won’t reduce! The burden of the backlog is on all our shoulders. And my centre, Hammersmith Hospital, has one of the shorter lists! 


Get seen quickly

If you need TAVI quickly, I can’t recommend my private practice enough. We take a patient-centred approach, so you’ll be seen quickly and professionally, with appointments that work around you.

Symptoms to watch out for

TAVI is a lifesaving treatment. If you have severe symptomatic aortic stenosis, you need urgent assessment and treatment.

Watch out for:

  1. Chest pain
  2. Breathlessness
  3. Dizziness or blackouts

Take the first step

Whether you’ve got symptoms of aortic stenosis and need further investigation or you’ve already been diagnosed with the condition, book your consultation with me today for life-changing treatment. Get the quality of your life back.

 Book your consultation


LIVE CASE TAVI with Dr Malik

Dr Malik will be doing a live case at an international meeting this week:

He says:
“It is a complicated situation with a previous TAVI in place and now a need for a second procedure. I am glad to be asked to join the team. Very few cases have been done in the world

The issues are:

1. Do we need to worry about the coronary arteries being covered by the new valve and blocked?
2. The old valve is oval and a rare type that is no longer used. It is a DFM TAVI- with a ceramic polymer in the rings. Can we make it circular?
3. What technology should we use? Balloon expandable or self- expanding.?
4. Should we push the valve out more after deployment- crack it or push it?

I have put the question out on social media as, having looked at the literature published, there is no right answer. It has generated a good discussion in the TAVI community. Again, no unified view, but that was what I expected, and I did it to educate others as much as myself!

I will tell you how it goes !”

Dr Malik explains the anatomy of the heart

Please see the below PDF that was created by Edwards Life Sciences as a free resource. Dr Malik works at Hammersmith Hospital London, and is a senior interventional cardiologist. He also works at OneWelbeck Heart Health, the largest private cardiology practice in London, and is the Medical Director.

Heart Anatomy Guide

Basics of the heart

The heart is a pump. Imagine a washing machine- It needs electricity- so does the heart (it has a built in electrical system). It needs a water supply –so does the heart (blood in this base). It needs the drum working –so does the heart (those are the heart chambers). To work properly, and beat 70-80 times per minute, al needs to be order- the heart lasts longer than any washing machine!


The chambers of the heart

The heart has 4 chambers.

The ones on the right side collect blood from the body and brain (the right atrium) and the  push it to the lungs (the right ventricle). This is a low pressure system. It only need to get to the lungs- they are close by. The pressure needed is about 30mmHg. The right ventricle 9s crescent shaped and wraps around the left ventricle.

The ones on the left collect blood from the lungs (the left atrium) and push it all over the body and brain (the left ventricle). The left ventricle is thus the most important chamber. It is bigger and stronger than the right ventricle and needs to generate 100-120 mmHg pressure to allow blood to pump to your brain when you are standing up. The left ventricle is like an ice-cream cone, with the right ventricle like your hand wrapped around it.


The electricity and pacing system in the heart

The heart has a built in pacemaker- it lives in the top of the right atrium. It is called the sino-atrial node (SA node).  It fires of at about 70 beats a minute until it needs to beat faster- when it can accelerate to over 180 if needed. It sends electricity around the atria making them contract.

It also fires off the secondary pacemaker – The atrio-ventricular node (AV node). It sits in the model of the heart. That is clever in that there is a built in delay- so that the atria have time to empty into the ventricles before they contract.

The AV node has “bundles” of cables that go to the left and right ventricles, again clever as then that means that the contraction of the ventricles occurs from the  apex of the “ice-cream cone”, so that efficiency is maximised.


The valves

Blood should only flow one way, just as water in the washing machine should only flow one way. The heart has 4 valves to help the 2 ventricles pump.

Right side- Inflow: tricuspid valve, outflow: pulmonary valve

Left side- Inflow: mitral valve, outflow : aortic valve

Problems with the right sided valves are tolerated better than left sided as the right is a low pressure system.

Valves can leak or narrow- just as in your washing machine.


Disease of the heart


  1. Too slow (bradycardia)- the pacemaker is failing and a new pacemaker may be needed
  2. Too fast (tachycardia)- there are other parts of the heart that accelerate the heart way above normal- this could be ventricular tachycardia (from the ventricle) or supra-ventricular tachycardia (above the ventricle). Treatment may be medication or cutting the short –circuit (ablation)
  3. Atrial fibrillation (AF)- that is usually tool fast a beat, but can also go too slow. Treatment is with medication or ablation.

Muscle disease (cardiomyopathy)

There are many types of these- affecting the ventricles- some with weakened and stretched (Dilated cardiomyopathy), some too chunky and thus not working well (hypertrophic cardiomyopathy). These will need specialist diagnosis and treatment.

Valve disease

The main ones in adults are:

  1. Aortic stenosis- the aortic valve is severely narrowed (stenosis) and you have chest pain, breathlessness or dizzy spells, seek urgent attention. Severe symptomatic aortic stenosis (SSAS) has a 4% per month death rate.
    1. Treatment can be with surgery or transcatheter aortic valve intervention  (TAVI or TAVR). Dr Malik is an expert in TAVI and run the Imperial College Healthcare NHS Trust program.
  2. Aortic regurgitation-the aortic valve is leaking, and this puts a strain on the left ventricle.
    1. Treatment can be with medication, with open heart surgery or with TAVI
  3. Mitral stenosis- the mitral valve is thickened and narrowed. this is mainly due to rheumatic heart disease, and thus is less common in western countries.
    1. Treatment is with medication, surgery, or balloon stretching- which in younger patient may avoid open heart surgery
  4. Mitral regurgitation- leaking mitral valve. This can be due to problems with the leaflets or problems with the ring the leaflets are on- if the ring stretches, then the leaflets don’t meet and the valve leaks.

Coronary disease:

Blood gets to the heart via coronary arteries. If these get narrowed, then the heart muscle is starved of oxygen and glucose. It cant work. This can happen slowly or suddenly

  1. Sudden blockage- a heart attack, or myocardial infarction (MI). Treatment is urgently needed. Muscle is dying every minute there is a delay. You should get to hospital and the cardiologist will try to open the blood vessel with an angioplasty and stent (known as PTCA or PCI). Dr Malik has treated 1000’s of heart attacks in the last 20 years.
  2. Slow progression- angina is caused by progressive narrowing. The heart can cope better with this, but it can lead to chest pain on exertion, breathlessness, or tiredness. Treatment may me medication, a PCI or Coronary artery bypass surgery (CABG). You will need tests and probably a coronary angiogram to decide the best treatment for you.

In this brief overview of the heart and its functions, Dr Malik has tried to cover some of the more common problems. What is clear is that the heart is an amazing organ. Look after it and it will keep going for nearly 100 years. As proven by Prince Phillip in March 2021.

Complex PFO closure with Dr Iqbal Malik

Dr Malik does a live PFO closure. A PFO or patent Foramen Ovale, is a flap in the heart that is needed in the womb, but serves no purpose in the adult. It can in rare cases be associated with stroke. Closing the PFO with an umbrella device leads to a much reduced chance of recurrent stroke. Dr Malik is a leading expert in the procedure, and as in this video, often demonstrates his techniques to other physicians. He works in London at Hammersmith Hospital, and OneWelbeck Heart Health.

Paravalvar Leak closure by Dr Malik

Dr Malik does a live Paravalvar leak (PVL)  closure- see the video of this highly complex case. The patient was very symptomatic with a huge hole in the centre of his heart, as a result of some sutures giving way a few months after lifesaving open heart surgery. He was now classed as inoperable by the surgeons who saved him the 1st time he was sick, Dr Malik put some “plugs” in and our patient has gone back to work!  This type of operation is done by a handful of operators in the UK- Dr Malik demonstrated this at a recent International meeting- the EST 2021 session on 13th February 2021. He works in London at Hammersmith Hospital, and OneWelbeck Heart Health.