Waiting for the new oral anticoagulants: questions and answers about dabigatran

Abstract

Dabigatran is the first oral thrombin inhibitor approved for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation and one or more risk factors for stroke. Dabigatran has also been approved in several countries for the prevention of venous thrombosis in patients undergoing total knee or hip replacement. The RE-LY (Randomized Evaluation of Long-Term Anticoagulant Therapy) study has shown that dabigatran 150 mg twice daily is superior to warfarin, and dabigatran 110 mg twice daily is non-inferior to warfarin, for the prevention of stroke and systemic embolism. Interestingly, the incidence of hemorrhagic stroke was significantly lower with dabigatran than with warfarin. Waiting for the introduction of dabigatran in the market in Italy for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation, several issues related to the use of dabigatran in clinical practice need to be addressed. The aim of this article is to clarify some practical issues concerning the use of this innovative drug.