title: New evidences for old concerns with oral anticoagulation in atrial fibrillation: focus on dabigatran.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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).
authors.affiliation: Hospital Ramón y Cajal, Department of Cardiology, Ctra. De Colmenar km 9, 100, Madrid, Spain. vbarrios.hrc@salud.madrid.org
authors.forename: Vivencio
authors.initials: V
authors.lastname: Barrios
authors.forename: Carlos
authors.initials: C
authors.lastname: Escobar
mesh_terms: D000284:Administration, Oral; D000991:Antithrombins / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000503:physiopathology; D001562:Benzimidazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000069604:Dabigatran; D004617:Embolism / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D019317:Evidence-Based Medicine; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D015091:beta-Alanine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran