title: Dabigatran etexilate: a novel oral thrombin inhibitor for thromboembolic disease.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of dabigatran etexilate, approved by the Food and Drug Administration (FDA) in October 2010 for the prevention of cardioembolic stroke in patients with atrial fibrillation; potential off-label use is treatment and prevention of venous thromboembolic disorders.
  
  
  METHODS
  Literature was accessed through MEDLINE (1977-April 2011) and International Pharmaceutical Abstracts (1977-April 2011) using the terms dabigatran, dabigatran etexilate, BIBR 1048, direct thrombin inhibitor, anticoagulant, and thromboembolism. In addition, US government Web sites, including clinicaltrials.gov and fda.gov, were reviewed for pertinent information. Lastly, reference citations from publications identified in the initial search were reviewed.
  
  
  METHODS
  All English-language articles identified from the data sources were evaluated. For the evaluation of clinical efficacy and safety, only Phase 2 and 3 studies are included in this review.
  
  
  RESULTS
  In 6 published Phase 3 trials to date, dabigatran has exhibited a similar efficacy and safety profile to that of comparator drugs, including dose-adjusted warfarin and enoxaparin, at various dosages. In the largest of these trials, RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy), dabigatran was at least as effective as dose-adjusted warfarin in reducing stroke or systemic embolism. Overall bleeding risks were similar; however, dabigatran may be associated with a lower incidence of intracranial bleeding and hemorrhagic stroke but a higher incidence of gastrointestinal bleeding. Although dabigatran is not approved for venous thromboembolism (VTE) prevention or treatment, results of the RE-MODEL and RE-NOVATE trials suggest similar efficacy to once-daily dosing of enoxaparin 40 mg but inferior efficacy to the FDA-approved twice-daily dosing of enoxaparin 30 mg in the RE-MOBILIZE trial.
  
  
  CONCLUSIONS
  Dabigatran is an effective and safe alternative to oral vitamin K antagonists for stroke prevention in patients with nonvalvular atrial fibrillation, with fewer drug interactions and monitoring requirements. Additionally, dabigatran may be a viable alternative to enoxaparin in VTE prevention and warfarin in VTE treatment, although current trial data are limited.
authors.affiliation: University of Florida, Gainesville, FL, USA.
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Bovio
authors.forename: Steven M
authors.initials: SM
authors.lastname: Smith
authors.forename: John G
authors.initials: JG
authors.lastname: Gums
mesh_terms: D058833:Antithrombin Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000009:adverse effects / Q000627:therapeutic use*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D000069604:Dabigatran; D006801:Humans; D056687:Off-Label Use; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D013917:Thrombin / Q000037:antagonists & inhibitors*; D013923:Thromboembolism / Q000188:drug therapy* / Q000517:prevention & control*
chemical_list: D058833:Antithrombin Proteins; D001562:Benzimidazoles; D011725:Pyridines; D013917:Thrombin; D000069604:Dabigatran