Dabigatran etexilate, a new oral direct thrombin inhibitor, for stroke prevention in patients with atrial fibrillation.
BACKGROUND
Warfarin is the only oral anticoagulant recommended for the prevention of ischemic stroke in atrial fibrillation. A newer and safer anticoagulant is needed because of increased hemorrhagic risks with warfarin, difficult-to-maintain therapeutic levels, and higher drug to drug and food interactions.


METHODS
Dabigatran etexilate is a new, effective, reversible, rapid-acting, oral direct inhibitor of thrombin. This review focuses on the results of major Phase II and III trials conducted to evaluate the use of dabigatran in prevention of stroke in atrial fibrillation.


RESULTS
The objective of this paper is to discuss the use of dabigatran for prevention of stroke in patients with atrial fibrillation and to review its major advantages and disadvantages over warfarin.


CONCLUSIONS
After the recent publication of Phase III trial RE-LY (randomized evaluation of long-term anticoagulation therapy), the use of dabigatran in atrial fibrillation is more clearly defined. A higher dose of dabigatran may be beneficial in patients who have recurrent ischemic events, despite therapeutic levels of warfarin. A lower dose is potentially safer than warfarin because of fewer hemorrhagic complications. Disadvantages include twice-daily dosing, dyspepsia and higher cost.
Siddiqui
Fazeel M
FM
Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN 55455, USA.
Qureshi
Adnan I
AI
D000284:Administration, Oral; D000925:Anticoagulants / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D001562:Benzimidazoles / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D000069604:Dabigatran; D004334:Drug Administration Schedule; D017048:Health Care Costs; D006801:Humans; D011355:Prodrugs; D011725:Pyridines / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D020521:Stroke / Q000209:etiology / Q000378:metabolism / Q000517:prevention & control*; D013917:Thrombin / Q000037:antagonists & inhibitors; D016896:Treatment Outcome
D000925:Anticoagulants; D001562:Benzimidazoles; D011355:Prodrugs; D011725:Pyridines; D013917:Thrombin; D000069604:Dabigatran