Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .
Dabigatran vs. warfarin in relation to the presence of left ventricular hypertrophy in patients with atrial fibrillation— the Randomized Evaluation of Long-term anticoagulation therapY (RE-LY) study
Abstract Aim We tested the hypothesis that left ventricular hypertrophy ( LVH ) interferes with the antithrombotic effects of dabigatran and warfarin in patients with atrial fibrillation ( AF ) . Methods and results This is a post-hoc analysis of the R and omized Evaluation of Long-term anticoagulation therapY ( RE-LY ) Study . We defined LVH by electrocardiography ( ECG ) and included patients with AF on the ECG tracing at entry .  Hazard ratios ( HR ) for each dabigatran dose vs. warfarin were calculated in relation to LVH . LVH was present in 2353 ( 22.7 % ) out of 10 372 patients . In patients without LVH , the rates of primary outcome were 1.59%/year with warfarin , 1.60 % with dabigatran 110 mg ( HR vs. warfarin 1.01 , 95 % confidence interval ( CI ) 0.75–1.36 ) and 1.08 % with dabigatran 150 mg ( HR vs. warfarin 0.68 , 95 % CI 0.49–0.95 ) . In patients with LVH , the rates of primary outcome were 3.21%/year with warfarin , 1.69 % with dabigatran 110 mg ( HR vs. warfarin 0.52 , 95 % CI 0.32–0.84 ) and 1.55 % with 150 mg ( HR vs. warfarin 0.48 , 95 % CI 0.29–0.78 ) . The interaction between LVH status and dabigatran 110 mg vs. warfarin was significant for the primary outcome ( P = 0.021 ) and stroke ( P = 0.016 ) . LVH was associated with a higher event rate with warfarin , not with dabigatran . In the warfarin group , the time in therapeutic range was significantly lower in the presence than in the absence of LVH . Conclusions LVH was associated with a lower antithrombotic efficacy of warfarin , but not of dabigatran , in patients with AF . Consequently , the relative benefit of the lower dose of dabigatran compared to warfarin was enhanced in patients with LVH . The higher dose of dabigatran was superior to warfarin regardless of LVH status . Clinical trial registration http : www . clinical trials.gov . Unique identifier : NCT00262600
Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .