Dabigatran Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation: An Evidence Based Case Report
Abstract
Background. Atrial fibrillation (AF) increases the risk of having stroke as high as five fold. Anticoagulant administration such as vitamin K antagonist has been used regularly to reduce the occurence of stroke. Despite the high efficacy, warfarin has several limitations, including a narrow therapeutic window, multiple food and drug interactions, and the need for frequent laboratory monitoring. Dabigatran, an oral thrombin inhibitor, displays some positive characteristics as the solution to warfarin’s limitations.Aim. To determine the efficacy of dabigatran compared to warfarin for stroke prevention in patients with atrial fibrillation.
Methods. A search was conducted on PubMed and Google. The selection of title and abstract was done using inclusion and exclusion criteria. Five original articles were found, but only one study was used. The selected study was critically appraised for its validity, importance and applicability.
Result. The administration of 150 mg of dabigatran was superior to warfarin with respect of stroke. The relative risk reduction was 36% in the 150 mg dabigatran group. The rate of stroke was 1.01% per year in the group that received 150 mg dabigatran, as compared with 1.57% per year in the warfarin group (relative risk 0.64; 95% confidence interval, 0.51 to 0.81, p<0.001). The administration of dabigatran increased the risk of gastrointestinal bleeding.
Conclusion. In patients with atrial fibrillation, dabigatran given at a dose of 150 mg, as compared with warfarin, was associated with lower rate of stroke. Dabigatran administration requires closed gastrointestinal monitoring.
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References
Roger VL, Go AS, LloydJones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation 2011; 123: e18–e209
Sikka P, Bindra VK. Newer antithrombotic drug. Indian J Crit Care Med. 2010; 14: 188–95
Ogawa S, Koretsune Y, Yasaka M, Aizawa Y, Atarashi H, Inoue H et al. Antithrombotic therapy in atrial fibrillationevaluation and positioning of new oral anticoagulant agents. Circ J2011; 75: 1539 –47.
Ezekowitz MD, Reilly PA, Nehmiz G, Simmers TA, Nagarakanti Rm ParchamAzad K et al. Dabigatran with or without concomitant aspirin compared with warfarin alone in patients with nonvalvular atrial fibrillation (PETRO Study). Am J Cardiol 2007; 100: 141926.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 113951.
Centre for Evidence Based Medicine. Oxford Centre for Evidencebased MedicineLevel of Evidence. CEBM. [cited 2011 April 4]. Available from: URL:HYPERLYNK http://www.cebm.net/index.aspx?o=5513
Sikka P, Bindra VK. Newer antithrombotic drug. Indian J Crit Care Med. 2010; 14: 188–95
Ogawa S, Koretsune Y, Yasaka M, Aizawa Y, Atarashi H, Inoue H et al. Antithrombotic therapy in atrial fibrillationevaluation and positioning of new oral anticoagulant agents. Circ J2011; 75: 1539 –47.
Ezekowitz MD, Reilly PA, Nehmiz G, Simmers TA, Nagarakanti Rm ParchamAzad K et al. Dabigatran with or without concomitant aspirin compared with warfarin alone in patients with nonvalvular atrial fibrillation (PETRO Study). Am J Cardiol 2007; 100: 141926.
Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361: 113951.
Centre for Evidence Based Medicine. Oxford Centre for Evidencebased MedicineLevel of Evidence. CEBM. [cited 2011 April 4]. Available from: URL:HYPERLYNK http://www.cebm.net/index.aspx?o=5513
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How to Cite
Nursalim, A., & Yuniadi, Y. (1). Dabigatran Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation: An Evidence Based Case Report. Indonesian Journal of Cardiology, 32(4), 249-54. https://doi.org/10.30701/ijc.v32i4.86
Section
Case Reports
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