Garnock–Jones KP – Dabigatran etexilate is a promising new option for the prevention of stroke and systemic embolism in patients with atrial fibrillation. Dabigatran etexilate 150 mg twice daily is more effective than warfarin for the prevention of stroke and systemic embolism in patients with atrial fibrillation, and is generally well tolerated, particularly with regard to bleeding endpoints compared with warfarin. It requires more frequent administration than warfarin, but provides multiple improvements to various issues associated with warfarin administration.
- Dabigatran etexilate is a prodrug of the direct thrombin inhibitor dabigatran, a direct, reversible, potent inhibitor of thrombin.
- Dabigatran does not interact with food, and is associated with very few known drug interactions.
- The higher dosage was associated with significantly greater efficacy than warfarin with regard to the incidence of stroke or systemic embolism .
- Dabigatran etexilate is well tolerated, although it is associated with a higher rate of dyspepsia than warfarin.
- Major bleeding was as common in recipients of the higher dosage as, and less common in recipients of the lower dosage of dabigatran etexilate than, that in recipients of warfarin, and intracranial bleeding, life–threatening major bleeding and total bleeding were less common in recipients of either dabigatran etexilate dosage than in warfarin recipients.
- The higher dosage of dabigatran etexilate was associated with a higher rate of gastrointestinal bleeding than warfarin was.
- The incidence of hepatotoxicity did not significantly differ across treatment groups.