title: Practical use of dabigatran etexilate for stroke prevention in atrial fibrillation.
abstract: Atrial fibrillation (AF) is associated with an increased risk of thromboembolism, and is the most prevalent factor for cardioembolic stroke. Vitamin K antagonists (VKAs) have been the standard of care for stroke prevention in patients with AF since the early 1990s. They are very effective for the prevention of cardioembolic stroke, but are limited by factors such as drug-drug interactions, food interactions, slow onset and offset of action, haemorrhage and need for routine anticoagulation monitoring to maintain a therapeutic international normalised ratio (INR). Multiple new oral anticoagulants have been developed as potential replacements for VKAs for stroke prevention in AF. Most are small synthetic molecules that target thrombin (e.g. dabigatran etexilate) or factor Xa (e.g. rivaroxaban, apixaban, edoxaban, betrixaban, YM150). These drugs have predictable pharmacokinetics that allow fixed dosing without routine laboratory monitoring. Dabigatran etexilate, the first of these new oral anticoagulants to be approved by the United States Food and Drug Administration and the European Medicines Agency for stroke prevention in patients with non-valvular AF, represents an effective and safe alternative to VKAs. Under the auspices of the Regional Anticoagulation Working Group, a multidisciplinary group of experts in thrombosis and haemostasis from Central and Eastern Europe, an expert panel with expertise in AF convened to discuss practical, clinically important issues related to the long-term use of dabigatran for stroke prevention in non-valvular AF. The practical information reviewed in this article will help clinicians make appropriate use of this new therapeutic option in daily clinical practice.
authors.affiliation: 3rd Department of Medicine (Cardiology and Emergency Medicine), Wilhelminen Hospital, Vienna, Austria. kurt.huber@wienkav.at
authors.forename: K
authors.initials: K
authors.lastname: Huber
authors.forename: S J
authors.initials: SJ
authors.lastname: Connolly
authors.forename: A
authors.initials: A
authors.lastname: Kher
authors.forename: F
authors.initials: F
authors.lastname: Christory
authors.forename: G-A
authors.initials: GA
authors.lastname: Dan
authors.forename: R
authors.initials: R
authors.lastname: Hatala
authors.forename: R G
authors.initials: RG
authors.lastname: Kiss
authors.forename: B
authors.initials: B
authors.lastname: Meier
authors.forename: B
authors.initials: B
authors.lastname: Merkely
authors.forename: B
authors.initials: B
authors.lastname: Pieske
authors.forename: T
authors.initials: T
authors.lastname: Potpara
authors.forename: J
authors.initials: J
authors.lastname: Stępińska
authors.forename: N Vene
authors.initials: NV
authors.lastname: Klun
authors.forename: D
authors.initials: D
authors.lastname: Vinereanu
authors.forename: P
authors.initials: P
authors.lastname: Widimský
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001281:Atrial Fibrillation / Q000188:drug therapy*; D001562:Benzimidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D000069604:Dabigatran; D004347:Drug Interactions; D004415:Dyspepsia / Q000139:chemically induced / Q000517:prevention & control; D004554:Electric Countershock / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced; D018579:Patient Selection; D011725:Pyridines / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D020521:Stroke / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D001562:Benzimidazoles; D011725:Pyridines; D000069604:Dabigatran
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