Dabigatran, a direct thrombin inhibitor, is the first oral alternative to warfarin for stroke prevention in atrial fibrillation. Dabigatran offers several potential advantages over warfarin including ease of dosing, fewer drug interactions, and the lack of required coagulation monitoring. However, its overall effectiveness and safety will depend upon appropriate patient selection. This article discusses factors that should be taken into account when considering dabigatran for patients with atrial fibrillation.
Get full access to this article
View all access options for this article.
References
1.
GoA.S.HylekE.M.PhillipsK.A.Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm PATAF management and stroke prevention – the anticoagulation and risk factors in atrial fibrillation (ATRIA) study. JAMA.2001; 285: 2370–2375.
2.
NaccarelliG.V.VarkerH.LinJ.SchulmanK.L.Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol.2009; 104: 1534–1539.
3.
FalkR.H.Atrial fibrillation. N Engl J Med.2001; 344: 1067–1077.
4.
Atrial Fibrillation Investigators.Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomized controlled trials. Arch Intern Med.1994; 154: 1449–1457.
5.
SingerD.E.AlbersG.W.DalenJ.E.Antithrombotic therapy in atrial fibrillation. Chest.2008; 133(6): 546S–592S.
StangierJ.ClemensA.Pharmacology, pharmacokinetics, and pharmacodynamics of dabigatran etexilate, an oral direct thrombininhibitor. Clin Appl Thromb Hemost.2009; 15(suppl 1): 9S–16S.
8.
HankeyG.J.EikelboomJ.W.Dabigatran etexilate a new oral thrombin inhibitor. Circulation.2011; 123: 1436–1450.
9.
ConnellyS.J.EzekowitzM.D.YusufS.; for the RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med.2009; 361: 1139–1151.
10.
FDA drug safety communication: safety review of post-market reports of serious bleeding events with the anticoagulantPradaxa (dabigatran etexilate mesylate). http://www.fda.gov/Drugs/DrugSafety/ucm282724.htm. Accessed December 15, 2011.
BakerW.L.CiosD.A.SanderS.D.ColemanC.I.Metaanalysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. J Manag Care Pharm.2009; 15: 244–252.
13.
GoA.S.HylekE.M.ChangY.Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice?JAMA.2003; 290: 2685–2692.
14.
Birman-DeychE.RadfordM.J.NilasenaD.S.GageB.F.Use and effectiveness of warfarin in Medicare beneficiaries with atrial fibrillation. Stroke.2006; 37: 1070–1074.
15.
Van RynJ.StandierJ.LiesenfeldK-HDabigatran etexilate: a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity. Thromb Haemost.2010; 103: 1116–1127.
16.
LiesenfeldK-HSchäferH.G.TroconizI.F.TillmannC.ErikssonB.I.StangierJ.Effects of the direct thrombin inhibitor dabigatran on ex vivo coagulation time in orthopedic surgery patients: a population model analysis. Br J Clin Pharmacol.2006; 62: 527–537.
HorlockerT.T.WedelD.J.RowlingsonJ.C.Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (3rd ed.). Reg Anesth Pain Med.2010; 35(1): 64–101.
19.
Pradaxa [product information]. Boehringer Ingelheim. Revised November 2011.
20.
FreemanJ.V.ZhuR.P.OwensD.K.Cost-effectiveness of dabigatran compared with warfarin for stroke prevention in atrial fibrillation. Ann Intern Med.2011; 154: 1–11.
21.
SorensenS.V.KansalA.R.ConnollyS.Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation: a Canadian payer perspective [published online ahead of print March 22, 2011]. Thromb Haemost. 201; 105: 908–919.
