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Preventing Cardioembolic Stroke in Atrial Fibrillation with Dabigatran

  • Stroke (HP Adams Jr, Section Editor)
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Abstract

Dabigatran is a direct inhibitor of thrombin that has recently been approved for primary and secondary stroke prevention and prevention of systemic embolism in patients with atrial fibrillation. The RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy [with Dabigatran Etexilate]) study showed that dabigatran given at a dose of 110 mg twice a day (bid) was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin (International Normalized Ratio target 2.0–3.0), and lower rates of major hemorrhage. Dabigatran administered at a dose of 150 mg bid was significantly more effective compared with warfarin and showed a similar rate of major hemorrhages. Both dosages resulted in an approximately 60% to 70% relative reduction of intracranial hemorrhage. The dosage of 110 mg bid should be preferably used in patients older than 75 years at a higher bleeding risk. The Hemoclot (Hyphen BioMed, Mason, OH) test to measure dabigatran serum concentration is commercially available, but presence of the drug may also be detected using the activated partial thromboplastin time or thrombin time.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Disclosure

Conflicts of interest: C. Weimar: has been a consultant for Bayer and Bristol-Myers Squibb; has received speakers’ or consultancy honoraria from Bayer, Bristol-Myers Squibb, and Sanofi-Aventis; and has received travel/accommodations expenses covered or reimbursed for investigator meetings of clinical studies by Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, D-Pharm, Lundbeck, Pfizer, PhotoTera, an Sanofi-Aventis; S.H. Hohnloser: has been a consultant for Sanofi-Aventis, Boehringer Ingelheim, Bayer, Bristol-Myers Squibb, Johnson & Johnson, and Pfizer; and has received honoraria from Sanofi-Aventis, Boehringer Ingelheim, Bayer, Bristol-Myers Squibb, and Pfizer; J.W. Eikelboom: has received grant support from Bristol-Myers Squibb, Boehringer Ingelheim, and Sanofi-Aventis; has been a consultant for Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, AstraZeneca, and Novartis; and has received honoraria from Bristol-Myers Squibb, Sanofi-Aventis, Eli Lilly, AstraZeneca, and Boehringer Ingelheim; H.-C. Diener: has received fees as Chairman of Adjudication committee in the RE-LY trial from Boehringer Ingelheim; has received grant support from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Novartis, Janssen-Cilag, Sanofi-Aventis, German Research Council (DFG), German Ministry of Education and Research (BMBF), European Union, National Institutes of Health, Bertelsmann Foundation, and Heinz-Nixdorf Foundation; has received honoraria from Abbott, Allergan, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, D-Pharm, EV3, Fresenius, GlaxoSmithKline, Janssen-Cilag, Knoll, Merck Sharp & Dohme, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Sankyo, Schering-Plough, Servier, Solvay, Thrombogenics, Wyeth, and Yamaguchi; has received payment for manuscripts from Boehringer Ingelheim and Sanofi-Aventis; has received payment for development of educational presentations including service on speakers’ bureaus for Abbott, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Merck Sharp & Dohme,, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Sankyo, Servier, Solvay, Thrombogenics, Wyeth, and Yamaguchi; and has received travel/accommodations expenses covered or reimbursed by Abbott, Allergan, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, D-Pharm, EV3, Fresenius, GlaxoSmithKline, Janssen-Cilag, Knoll, Merck Sharp & Dohme, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, Sanofi-Aventis, Sankyo, Schering-Plough, Servier, Solvay, Thrombogenics, Wyeth, and Yamaguchi.

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Authors and Affiliations

  1. Department of Neurology and Stroke Unit, University of Duisburg- Essen, Hufelandstrasse 55, 45147, Essen, Germany

    Christian Weimar & Hans-Christoph Diener

  2. Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Theodor Stern Kai 7, 60590, Frankfurt, Germany

    Stefan H. Hohnloser

  3. Department of Medicine, McMaster University, Population Health Research Institute, 237 Barton Street East, Hamilton, Ontario, Canada, L8L 2X2

    John W. Eikelboom

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  1. Christian Weimar
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  2. Stefan H. Hohnloser
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  3. John W. Eikelboom
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  4. Hans-Christoph Diener
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Correspondence to Hans-Christoph Diener.

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Weimar, C., Hohnloser, S.H., Eikelboom, J.W. et al. Preventing Cardioembolic Stroke in Atrial Fibrillation with Dabigatran. Curr Neurol Neurosci Rep 12, 17–23 (2012). https://doi.org/10.1007/s11910-011-0229-4

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  • DOI: https://doi.org/10.1007/s11910-011-0229-4

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