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Published on: February 28, 2012
Preventing cardioembolic stroke in atrial fibrillation with dabigatran
Christian Weimar1, Stefan H Hohnloser, John W Eikelboom
1Department of Neurology and Stroke Unit, University of Duisburg - Essen, Hufelandstrasse 55, 45147, Essen, Germany. christian.weimar@uk-essen.de
Insights
Dabigatran effectively prevents stroke in atrial fibrillation patients, showing similar efficacy to warfarin with reduced bleeding. Higher doses offer greater stroke prevention but similar bleeding risk compared to warfarin.
Area of Science:
- Cardiology
- Pharmacology
- Neurology
Background:
- Atrial fibrillation (AF) increases stroke and embolism risk.
- Warfarin is a traditional anticoagulant but has limitations.
- Dabigatran is a novel direct thrombin inhibitor for AF-related thromboembolism.
Purpose of the Study:
- To evaluate dabigatran's efficacy and safety versus warfarin for stroke prevention in AF.
- To compare different dabigatran dosages (110 mg bid and 150 mg bid) against warfarin.
Main Methods:
- The RE-LY study was a randomized, controlled trial.
- Patients with AF received dabigatran (110 mg or 150 mg bid) or warfarin.
- Primary outcomes included stroke and systemic embolism; secondary outcomes included major hemorrhage.
Main Results:
- Dabigatran 110 mg bid showed similar stroke/embolism rates to warfarin with less major hemorrhage.
- Dabigatran 150 mg bid was more effective than warfarin, with similar major hemorrhage rates.
- Both dabigatran doses significantly reduced intracranial hemorrhage by 60-70%.
Conclusions:
- Dabigatran is a safe and effective alternative to warfarin for stroke prevention in AF.
- The 110 mg bid dose is preferred for elderly patients (>75 years) or those at high bleeding risk.
- Dabigatran monitoring can be done via Hemoclot assay, aPTT, or TT.
Abstract:
Dabigatran is a direct inhibitor of thrombin that has recently been approved for primary and secondary stroke prevention and prevention of systemic embolism in patients with atrial fibrillation. The RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy [with Dabigatran Etexilate]) study showed that dabigatran given at a dose of 110 mg twice a day (bid) was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin (International Normalized Ratio target 2.0-3.0), and lower rates of major hemorrhage. Dabigatran administered at a dose of 150 mg bid was significantly more effective compared with warfarin and showed a similar rate of major hemorrhages. Both dosages resulted in an approximately 60% to 70% relative reduction of intracranial hemorrhage. The dosage of 110 mg bid should be preferably used in patients older than 75 years at a higher bleeding risk. The Hemoclot (Hyphen BioMed, Mason, OH) test to measure dabigatran serum concentration is commercially available, but presence of the drug may also be detected using the activated partial thromboplastin time or thrombin time.
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