New anticoagulant option 'could replace warfarin'

European Society of Cardiology Congress Dabigatran reduces bleeding. Clopidogrel alternative found.

Warfarin is effective in stroke prevention but requires monitoring
Warfarin is effective in stroke prevention but requires monitoring

The thrombin inhibitor dabigatran could replace warfarin for stroke prevention in patients with atrial fibrillation (AF), after research found it was safer and more effective.

Currently, warfarin is the most effective treatment for lowering stroke risk in AF patients, but it interacts with food and other medications, requires regular monitoring and can increase the risk of haemorrhage.

The findings of the RELY trial showed that dabigatran could be an effective alternative.

Researchers gave 18,113 AF patients either dabigatran 110mg or 150mg twice daily, or an adjusted dose of warfarin for two years.

Dabigatran 110mg reduced the risk of stroke and embolism about as much as warfarin. But the use of dabigatran was associated with lower rates of major bleeding - 2.71 per cent per year compared with 3.36 per cent per year for warfarin.

The 150mg dose of dabigatran produced a 34 per cent reduction in stroke compared with warfarin but did not have the same safety profile as the lower dose.

West London GP Dr Sarah Jarvis said: 'This is the one area where we are desperate for new drugs. Currently, if a patient cannot tolerate warfarin, we only have aspirin.

'There is no monitoring and no drug and food interactions with this drug. Virtually all the warfarin monitoring is now done by GPs so the use of dabigatran would prove to be cost-effective by freeing GP time.'

Dr Keith Muir, medical advisor for the Stroke Association, told GP: 'Warfarin is highly effective when indicated for stroke prevention, but is underused, often because of safety concerns or the need for regular blood tests to monitor effects.

'The RELY trial indicates that dabigatran may offer a useful alternative to warfarin for stroke prevention in some circumstances, but the trial highlights both pros and cons that mean its place isn't yet clear.

'The trial only involved people who could equally well have taken warfarin, and anyone currently taking warfarin should continue it unless advised by their doctor.'

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