Dabigatran for stroke prevention in atrial fbrillation

Abstract

Recently endorsed by the National Institute for Health and Clinical Excellence, dabigatran, a direct thrombin inhibitor, is licensed for the prevention of stroke in patients with atrial fibrillation and additional risk factors. There are some groups of patients unable to take warfarin where use is compelling. Patients unable to achieve adequate INR control on warfarin should also be considered for dabigatran therapy. Cost may delay the rollout of dabigatran into clinical practice. Key practical considerations for patients prescribed dabigatran are to assess and manage bleeding risk, which will change over time, renal monitoring and dose adjustment as the patient ages—the higher dose is contraindicated in the over-80 age group. Patient adherence will be a critical factor in determining the efficacy of dabigatran outside of clinical trial setting. Patients should be counselled on the reason for anticoagulant therapy, benefits and risks of therapy, and importance of compliance to the treatment to minimise their stroke risk.