Dabigatran comparable with warfarin in atrial fibrillation and previous TIA or stroke

January 01, 0001

Dabigatran comparable with warfarin in atrial fibrillation and previous TIA or stroke

In the Randomised Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial, dabigatran reduced occurrence of both stroke and haemorrhage compared with warfarin in patients who had atrial fibrillation and were at increased risk of stroke. The researchers from Germany, Canada, USA, Sweden, India and Italy aimed to assess the effects of dabigatran compared with warfarin in the subgroup of patients with previous stroke or transient ischaemic attack, where 1195 patients were from the 110 mg dabigatran group, 1233 from the 150 mg dabigatran group, and 1195 from the warfarin group.

Stroke or systemic embolism occurred in 2.78% patients per year on warfarin compared with 2.32% per year on 110 mg dabigatran (relative risk, RR: 0.84) and 2.07% per year on 150 mg dabigatran (RR 0.75). The rate of major bleeding was significantly lower in patients on 110 mg dabigatran (RR 0.66) and similar in those on 150 mg dabigatran (RR 1.01) compared with those on warfarin. The effects of both doses of dabigatran compared with warfarin were not significantly different between patients with previous stroke or transient ischaemic attack and those without for any of the outcomes from RE-LY apart from vascular death (110 mg group compared with warfarin group).

"In patients with previous stroke or transient ischaemic attack, the effects of 110 mg dabigatran and 150 mg dabigatran on stroke or systemic embolism were similar to those of warfarin. Most effects of both dabigatran doses were consistent in patients with versus those without previous stroke or transient ischaemic attack."

This is looking to be a promising drug, but needs to be still watched for side-eefects.

For the full abstract, click here.

The Lancet Neurology 9(12):1157-1163 December 2010 © 2010 Elsevier Limited
Dabigatran compared with warfarin in patients with atrial fibrillation and previous transient ischaemic attack or stroke: a subgroup analysis of the RE-LY trial. Hans-Christoph Diener, Stuart J Connolly, Michael D Ezekowitz et al for the RE-LY study group. Correspondence to Hans-Christoph Diener: [email protected]

Category: B. Blood/Blood Forming Organs/Immune Mechanisms, K. Circulatory, N. Keywords: dabigatran, warfarin, atrial fibrillation, TIA, stroke, RE-LY trial, subgroup analysis, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 17 December 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.