Abstract 484: Real World Experience with the Use of Dabigatran

Abstract

Background The RE-LY trial in 2009 ushered in a new era in anticoagulation options for stroke prevention in atrial fibrillation.We sought to determine the safety, efficacy, and tolerability of dabigatran in a community setting. Methods We retrospectively reviewed demographics, bleeding rates, stroke rates, and reasons for discontinuation in patients on dabigatran for non-valvular atrial fibrillation. Results Of the 263 patients, mean age was 73.8 years (32 to 96) and 41.06% were female. The 150 mg BID dose was used in 93.54% of patients and 75 mg BID in 6.46%. Major bleeding was noted in 4 (1.52%), minor bleeding in 25 (9.5%), and rate of discontinuation was 22.3%. Patients who experienced major bleeding were more likely to be older, male, have higher HAS-BLED scores, and a history of gastrointestinal bleeds. All these patients were managed conservatively with no mortality.Of note, three of the four patients with major bleeds were on amiodarone in addition to dabigatran 150 mg BID.Two presented with transient ischemic attacks and had elevated PTTs suggesting compliance with dabigatran. Four patients who were admitted to the hospital with pneumonia, atrial fibrillation, and COPD exacerbation had elevated troponins without accompanying symptoms of acute coronary syndrome. In patients maintained on the 75 mg BID dose, minor bleeding was noted in two, who were also on dronedarone. No strokes or intracranial bleeds were noted in patients on either dose of dabigatran Conclusions This retrospective analysis demonstrates safety and efficacy of dabigatran as an oral anticoagulant in patients with non-valvular atrial fibrillation over a two-year follow-up while describing the factors associated with increased bleeding risk.It is the first study to describe experience with use of 75 mg of dabigatran. Drug interactions are a common and avoidable reason for dabigatran-associated bleeding and were noted with both amiodarone and dronedarone in our study. There was no increased incidence of myocardial infarction noted. In our study population, dabigatran is safe, effective, and convenient when there is careful patient selection with consideration of renal function and possible drug-drug interactions