Dabigatran for stroke prevention in atrial fibrillation: from RE-LY to daily clinical practice

The RE-LY trial has shown that the oral direct thrombin inhibitor dabigatran etexilate is a valid replacement for oral anticoagulation with vitamin K antagonists (VKA) in patients with atrial fibrillation at thromboembolic risk. After a decade of failures, these results signify a breakthrough in anticoagulation management. This article summarizes the available evidence from the perspective of the practicing clinician: do the results apply to all patients with AF? And what considerations should we make when prescribing this new oral anticoagulant?

We review the trials searching for oral alternatives to VKA therapy, with emphasis on the RE-LY data.We have integrated available interaction data, and data on how to deal with side effects and (bleeding) complications with the direct thrombin inhibitor dabigatran etexilate.

abigatran etexilate is a viable alternative to VKA, improving efficacy and safety in many respects, for many patients, and likely preferred by most patients themselves. Choosing the dose should be based on patient-specific factors. These include the presence of coronary artery disease (with potential requirement of concomitant aspirin +/- clopidogrel), decreased renal function, age, low body weight, administration of otherAF drugs or P-glycoprotein inhibitors, a history of gastro-intestinal bleeding, and patient compliance.