Increased risk of myocardial infarction with dabigatran: fact or fiction?
Dabigatran is a direct, competitive inhibitor of thrombin recently approved for the prophylaxis of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. In some of the clinical trials evaluating the efficacy and safety of dabigatran in different clinical settings [i.e., prevention of venous thromboembolism (VTE) after orthopedic surgery, secondary prevention of VTE, and acute coronary syndromes (ACS)], a trend toward an increase in acute coronary events among patients receiving dabigatran has been reported, thus raising concerns of a possible relationship between dabigatran and myocardial infarction, especially in high-risk patients. However, as shown in our article, current evidence is inconclusive on this topic; more data are needed to detail this hypothetical association, and other considerations, such as the well-known protective effect of warfarin against ACS, should be taken into account as a possible explanation.
aInstitute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy bStanford University School of Medicine, Stanford, California, USA cTexas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA dUniversity of Foggia, Foggia, Italy.
Ada F
AF
Giglio
Eloisa
E
Basile
Pasquale
P
Santangeli
Luigi
L
Di Biase
Francesco
F
Trotta
Andrea
A
Natale
D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D000991:Antithrombins / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D001562:Benzimidazoles / Q000009:adverse effects*; D000069604:Dabigatran; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood / Q000401:mortality / Q000517:prevention & control*; D015091:beta-Alanine / Q000009:adverse effects / Q000031:analogs & derivatives*
D000991:Antithrombins; D001562:Benzimidazoles; D015091:beta-Alanine; D000069604:Dabigatran