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Updated: May 16, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
New evidences for old concerns with oral anticoagulation in atrial fibrillation: focus on dabigatran
Vivencio Barrios1, Carlos Escobar
1Hospital Ramón y Cajal, Department of Cardiology, Ctra. De Colmenar km 9, 100, Madrid, Spain. vbarrios.hrc@salud.madrid.org
Introduction:
Nonvalvular atrial fibrillation (NVAF) is associated with a fivefold excess risk of stroke. Antithrombotic therapy is crucial to reduce the risk of stroke. During past decades, vitamin K antagonists (warfarin or acenocoumarol) have been widely used for this purpose. However, they have several disadvantages that limit their daily use in clinical practice.
Areas Covered:
In patients with NVAF at risk of stroke, the randomized evaluation of long-term anticoagulation therapy (RE-LY) trial demonstrated that, compared with warfarin, dabigatran 150 mg b.i.d. was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage, whereas dabigatran 110 mg b.i.d. exhibited similar rates of stroke and systemic embolism, but lower rates of major hemorrhage. Fortunately, data about dabigatran are not limited to RE-LY trial. In fact, many substudies have been drawn, providing new and important evidences about the benefits of dabigatran.
Expert Opinion:
The most recent evidences about efficacy and safety of dabigatran in patients with NVAF, focusing on different substudies of RE-LY trial, are reviewed. In summary, dabigatran is beneficial not only in general population with NVAF but also in different subgroups of patients or different clinical settings (i.e., CHADS2 score, INR control, type of AF, elderly, previous transient ischemic attack or stroke, cardioversion and so on).
Insights
Dabigatran effectively reduces stroke risk in nonvalvular atrial fibrillation (NVAF) patients. Substudies confirm its benefits across various patient groups and clinical scenarios, offering an alternative to warfarin.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Nonvalvular atrial fibrillation (NVAF) significantly increases stroke risk.
- Antithrombotic therapy is essential for stroke prevention in NVAF.
- Vitamin K antagonists have limitations in clinical practice.
Purpose of the Study:
- To review recent evidence on dabigatran's efficacy and safety in NVAF patients.
- To analyze data from RE-LY trial substudies.
- To assess dabigatran's benefits in diverse NVAF subgroups.
Main Methods:
- Review of multiple dabigatran substudies from the RE-LY trial.
- Comparison of dabigatran (150 mg and 110 mg b.i.d.) with warfarin.
- Analysis of efficacy and safety outcomes in various patient populations.
Main Results:
- Dabigatran 150 mg b.i.d. showed lower stroke/systemic embolism rates than warfarin with similar major hemorrhage rates.
- Dabigatran 110 mg b.i.d. demonstrated similar stroke/systemic embolism rates and lower major hemorrhage rates compared to warfarin.
- Evidence supports dabigatran's benefits in general NVAF population and specific subgroups.
Conclusions:
- Dabigatran offers significant benefits for stroke prevention in NVAF patients.
- The drug is effective across diverse patient subgroups and clinical settings.
- Dabigatran represents a valuable therapeutic option for NVAF management.
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