Warfarin could be replaced for stroke prevention in AF patients

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.

Warfarin tablets (Photograph: TEK IMAGE / SCIENCE PHOTO LIBRARY)
Warfarin tablets (Photograph: TEK IMAGE / SCIENCE PHOTO LIBRARY)

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 in-crease the risk of haemorrhage.

The findings of the RELY trial, presented at the European Society of Cardiology congress in Barcelona, Spain, this week, showed that dabigatran could be an effective alternative to warfarin.

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 year compared with 3.36% per year for warfarin.

The higher dose of dabigatran (150mg) produced a 34% reduction in stroke com-pared with warfarin but did not have the same safety profile as the lower 110mg 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, the only other drug we have is aspirin.'

She added: ‘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, said: ‘Warfarin is a highly effective treatment when indicated for stroke prevention, but it is underused, often because of safety concerns or the need for regular blood tests to monitor its effects.

‘The RELY trial indicates that dabigatran may offer a useful alternative to warfarin for stroke prevention in some circumstances, but the trial high-lights 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.'

sanjay.tanday@haymarket.com

  • Read two pages of news from the conference in this week's GP dated 4 September.

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