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The Efficacy of Dabigatran versus Warfarin for Stroke Prevention in Patients With Atrial Fibrillation: Systematic Review

20 April 2011


Background: Patients with atrial fibrillation are at increased risk of experiencing embolic events. Anticoagulation therapy is known to reduce these events. Warfarin, the only oral anticoagulant available, gives inconsistent results, and thus requires frequent laboratory monitoring and adjustment. A newly FDA approved fixed-dosage direct thrombin inhibitor, dabigatran, has shown some promising results in efficacy and safety.

Method: An extensive review of the literature search was performed using the following database: Web of Science, MEDLINE and CINHAL. Two studies met the inclusion and exclusion criteria and were included in the final analysis.

Results: The two studies reviewed, showed dabigatran 150 mg, twice daily, demonstrated superiority in stroke and systemic embolism prevention compared with warfarin. At 110 mg, twice daily, dabigatran was non-inferior to warfarin. Major bleeding rates have been noted in higher doses of dabigatran with aspirin, otherwise, all other dosing was comparable to warfarin groups. A higher rate of dyspepsia was noted in patients taking dabigatran in each trials.

Conclusion: Now that it is approved by the FDA, dabigatran offers significant improvements in anticoagulation therapy for stroke and systemic embolism prevention in patients with atrial fibrillation. The fixed-dose will most likely make it easier and safer for patient to adhere to the prevention guidelines.


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