[Dabigatran: a new therapeutic alternative in the prevention of stroke].
Therapy with vitamin K antagonists (VKA) is especially feared because of its variable therapeutic effect. Direct thrombin inhibitors have been demonstrated to be safe and effective in preventing stroke in patients with atrial fibrillation (AF) eligible for inclusion in the RE-LY trial. Dabigatran provides equal or superior efficacy to VKA (110mg BID) and is much safer than VKA, with a similar safety margin (150mg BID). Dabigatran does not lead to liver dysfunction and does not require monitoring. The choice of dose should be based on specific patient characteristics (coronary disease, decreased renal function, age, low body weight, administration of other drugs for AF or P-glycoprotein inhibitors, history of gastrointestinal bleeding). Dabigatran is a viable alternative to VKA that provides many advantages over these drugs and is certainly preferred by most patients due to the problems of VKA follow-up.
Unidad de Ictus, Servicio de Neurología, Complejo Hospitalario de Navarra, Pamplona, Spain. jgallegoc@meditex.es
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Gállego
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Gil Alzueta
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000037:antagonists & inhibitors; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000150:complications; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D000069604:Dabigatran; D004311:Double-Blind Method; D004347:Drug Interactions; D004415:Dyspepsia / Q000139:chemically induced; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000991:Antithrombins; D001562:Benzimidazoles; D011725:Pyridines; D010959:Tissue Plasminogen Activator; D000069604:Dabigatran