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Dabigatran Etexilate: A Review of Its Use in the Treatment of Acute Venous Thromboembolism and Prevention of Venous Thromboembolism Recurrence

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Abstract

Dabigatran etexilate (Pradaxa®, Prazaxa®) has recently been approved for the treatment of acute venous thromboembolism (VTE) and prevention of VTE recurrence. Dabigatran etexilate is an oral prodrug of dabigatran, a selective, reversible, competitive, direct thrombin inhibitor. Dabigatran etexilate has a wide therapeutic range that allows for fixed-dose administration without the need for routine monitoring, a requirement of standard vitamin K antagonist (VKA) therapy. In randomized phase III trials in patients with acute VTE (RE-COVER and RE-COVER II), long-term treatment with oral dabigatran etexilate 150 mg twice daily for 6 months after initial parenteral anticoagulation was noninferior to dose-adjusted warfarin with regard to the incidence of recurrent symptomatic VTE or related death. In randomized trials of patients with previously treated VTE, extended dabigatran etexilate treatment was noninferior to warfarin (RE-MEDY) and significantly more effective than placebo (RE-SONATE) with regard to the incidence of recurrent VTE or related death. Dabigatran etexilate was generally well tolerated, with a similar incidence of major bleeding to that with warfarin in individual studies (although pooled data showed a significantly lower incidence in patients with acute VTE), and significantly lower incidences of the combined endpoint of major or clinically relevant nonmajor bleeding and of any bleeding than with warfarin. However, in the RE-SONATE trial, dabigatran etexilate was associated with a higher risk of bleeding than placebo. In conclusion, dabigatran etexilate is a valuable treatment option for acute VTE and prevention of VTE recurrence, providing an effective and convenient alternative to standard VKA therapy with the potential for a lower overall rate of bleeding.

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Disclosure

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on this article. Changes resulting from comments received were made by the authors on the basis of scientific and editorial merit. Sarah Greig and Kate McKeage are salaried employees of Adis/Springer.

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    Sarah L. Greig & Kate McKeage

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Correspondence to Sarah L. Greig.

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The manuscript was reviewed by: W. Dietrich, Institute for Research in Cardiac Anesthesia, Munich, Germany; A. Gallus, Department of Haematology, SA Pathology at Flinders Medical Centre, Adelaide, SA, Australia; D. J. Quinlan, Department of Radiology, King’s College Hospital, London, UK; G. Riccioni, Intensive Cardiology Care Unit, San Camillo de Lellis Hospital, Manfredonia, Foggia, Italy.

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Greig, S.L., McKeage, K. Dabigatran Etexilate: A Review of Its Use in the Treatment of Acute Venous Thromboembolism and Prevention of Venous Thromboembolism Recurrence. Drugs 74, 1785–1800 (2014). https://doi.org/10.1007/s40265-014-0304-7

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