title: Efficacy and safety of dabigatran in a "real-life" population at high thromboembolic and hemorrhagic risk: data from MonaldiCare registry.
abstract: OBJECTIVE
  Dabigatran is a novel target specific oral anticoagulant for stroke prevention in non valvular atrial fibrillation. Little is still known about its real-world effectiveness and safety in the italian population. Aim of our study was to evaluate the efficacy and safety of dabigatran in a large single-center cohort of "real-life" italian population with non-valvular AF and to compare the results with those obtained from the RE-LY trial and the Medicare study.
  
  
  METHODS
  We studied a prospective cohort of 2108 patients (1119 male; mean age 69.4 ± 9.4 years) who started the oral anticoagulant treatment with dabigatran 110 mg twice-daily (DAB 110; N = 1075; 51%) or 150 mg twice-daily (DAB 150; N = 1033; 49%). Follow-up data were obtained trough outpatients visits each 3-6 months for assessing the clinical status, adherence to treatment, occurrence of side effects and major cardiovascular complications.
  
  
  RESULTS
  In DAB 150 group the mean age was 64.9 ± 8.8 years, 56.8% of patients was male. CHA2DS2Vasc Score was ≥ 3 in 94.3% and HAS-BLED was ≥ 3 in 59.7%. In DAB 110 group (N = 1075) the mean age was 73.9 ± 7.5 years; 49.5% of patients was male. CHA2DS2Vasc Score was ≥ 3 in 73.4% and HAS-BLED was ≥ 3 in 87.4% of DAB 110 patients. One patient taking Dabigatran 110 mg bid had ischemic stroke without significantly neurological sequelae. In both groups, no patient experienced hemorrhagic stroke during the follow-up period. 147 patients (6.9%) of MonaldiCare population reported adverse effects from treatment with dabigatran, of whom 121 patients (5.7%) discontinued therapy. We reported one case of subarachnoid hemorrhage (0.05%) in a patient with high thrombo-embolic and high hemorrhagic risk score who was taking dabigatran 150 mg bid and one case (0.05%) of bladder bleeding in a patient who was taking dabigatran 110 mg bid. No major gastrointestinal bleeding was observed in the MonaldiCare population.
  
  
  CONCLUSIONS
  MonaldiCare registry showed a safety profile of both dosages of dabigatran regarding major of fatal bleeding in a "real life" single center italian population at high thromboembolic and hemorrhagic risk. The majority of MonaldiCare patients tolerated dabigatran treatment without significant side effects. The efficacy of dabigatran was demonstrated by very low prevalence of ictus/TIA, also when patients underwent electrical AF cardioversion independently of the transesophageal examination.
authors.affiliation: Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Monaldi Hospital, Naples, Italy. v.p.russo@libero.it.
authors.forename: V
authors.initials: V
authors.lastname: Russo
authors.forename: V
authors.initials: V
authors.lastname: Bianchi
authors.forename: C
authors.initials: C
authors.lastname: Cavallaro
authors.forename: F
authors.initials: F
authors.lastname: Vecchione
authors.forename: S
authors.initials: S
authors.lastname: De Vivo
authors.forename: L
authors.initials: L
authors.lastname: Santangelo
authors.forename: B
authors.initials: B
authors.lastname: Sarubbi
authors.forename: P
authors.initials: P
authors.lastname: Calabrò
authors.forename: G
authors.initials: G
authors.lastname: Nigro
authors.forename: A
authors.initials: A
authors.lastname: D'Onofrio
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000453:epidemiology; D015331:Cohort Studies; D000069604:Dabigatran / Q000009:adverse effects / Q000627:therapeutic use*; D004415:Dyspepsia / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology; D013923:Thromboembolism / Q000139:chemically induced / Q000453:epidemiology*; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D000069604:Dabigatran