Learning the respective roles of warfarin and dabigatran to prevent stroke in patients with nonvalvular atrial fibrillation.

摘要

In "the race to replace warfarin," the direct thrombin inhibitor dabigatran was the first off the starting block (1). In October 2010, the U.S. Food and Drug Administration (FDA) approved oral dabigatran at a dosage of 150 mg twice daily to reduce the risk for stroke and systemic embolism in persons with nonvalvular atrial fibrillation (2). This approval was largely based on results from the RE-LY (Randomized Evaluation of Long-term Anticoagulation Therapy) trial, which showed that the rates of stroke or systemic embolism and death each decreased by 0.5% per year with dabigatran, 150 mg twice daily, compared with adjusted-dose warfarin. The rates of major bleeding did not differ, but intracranial bleeding was less frequent with dabigatran (3).