Dabigatran versus warfarin for the prevention of stroke in patients with chronic nonvalvular atrial fibrillation.

摘要

Problem: Atrial fibrillation (AF) is the most common arrhythmia worldwide and a prominent risk factor for stroke. AF related strokes are generally associated with increased morbidity, mortality, medical costs, and recurrence. Primary prevention with vitamin K antagonists (VKAs), such as warfarin, has remained a crucial aspect of AF management. Despite its well-established clinical efficacy in stroke prevention, warfarin is significantly under-prescribed due to its inherent risks and limitations. Hence, a more effective, convenient, and safer alternative is necessary for optimal stroke prevention. Dabigatran is a novel oral direct thrombin inhibitor (DTI) that carries the potential to overcome many of the shortcomings related to warfarin therapy. Methods: A comprehensive literature review was conducted via an electronic journals database provided by Weill Cornell Medical College online library. Original and peer reviewed articles pertinent to warfarin versus dabigatran for AF related stroke are identified and reviewed. Results: Current literature review revealed robust evidence of superiority of dabigatran over warfarin in both stroke prevention and reduction in the incidence of systemic and intracranial hemorrhage. Although short-term use of dabigatran demonstrated a better risk-benefit profile as compared to warfarin therapy, dabigatran was associated with a higher incidence of myocardial infarction and gastrointestinal adverse events with uncertain long-term tolerability issues. Conclusions: While dabigatran appears to be a potential alternative to warfarin, long-term safety and tolerability issues need to be assessed to support the use of dabigatran over warfarin for stroke prevention in patients with nonvalvular AF.