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Dabigatran for atrial fibrillation: from RE-LY to real life practice

Kastanayan A. A., Arutyunov G. P.

Keywords: anticoagulants, stroke, therapy, atrial fibrillation

DOI: 10.18087/rhj.2013.3.1762

Three million earth dwellers yearly suffer stroke induced by atrial fibrillation (AF). AF not only 5 times increases the risk of stroke but also aggravates the stroke outcome; stroke associated with AF more often results in death and disability than stroke without AF. Prevention of stroke and thromboembolism is a priority therapeutic goal of AF treatment and antithrombotic therapy is a well-accepted method of primary and secondary prevention. Despite obvious clinical benefits in reducing the risk of stroke and thromboembolism, administration of vitamin K antagonists is complicated in some cases with severe hemorrhage, especially intracranial hemorrhage, which may lead to destructive sequences. Due to the concerns about fatal hemorrhage and difficulties in managing patients, the frequency of prescribing vitamin K antagonists remains low and does not correspond to the estimated risk of stroke. Novel oral anticoagulants (NOAC), dabigatran, rivaroxaban and apixaban, as distinct from varfarin, do not require INR monitoring and they have demonstrated a capability for reducing the incidence of intracranial hemorrhage. The direct thrombin inhibitor dabigatran more effectively than varfarin reduces the risk of both ischemic and hemorrhagic stroke with a similar risk of hemorrhage. Although data of clinical studies have convincingly supported the NOAC efficacy and good safety profile, it should be always kept in mind that the clinical experience of using these drugs is still limited and their administration requires continuous monitoring, alertness and regular reviewing the information on results of their use in clinical practice.
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Kastanayan A. A., Arutyunov G. P. Dabigatran for atrial fibrillation: from RE-LY to real life practice. Russian Heart Journal. 2013;12(3):172-185

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