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Review: Dabigatran Comparable to Warfarin for Nonvalvular A-Fib

Linked to lower risk of intracranial bleeding, but higher risk of gastrointestinal bleeding

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WEDNESDAY, Jan. 27, 2016 (HealthDay News) -- For patients with nonvalvular atrial fibrillation, dabigatran 150 mg is comparable to warfarin for preventing ischemic stroke, and correlates with lower risk of intracranial bleeding but higher risk of gastrointestinal bleeding, according to a review published online Jan. 26 in Circulation: Cardiovascular Quality and Outcomes.

Robert J. Romanelli, Ph.D., M.P.H., from the Palo Alto Medical Foundation Research Institute in California, and colleagues conducted a systematic review to examine the real-world evidence for the comparative effectiveness and safety of dabigatran versus warfarin in the treatment of nonvalvular atrial fibrillation. Data were included for seven retrospective cohort studies, with 348,750 patients followed for a mean of 2.2 years.

The researchers found that dabigatran 150 mg was not superior to warfarin for preventing stroke in pooled analyses (hazard ratio, 0.92; 95 percent confidence interval, 0.84 to 1.01), but was associated with a significantly lower risk of intracranial bleeding (hazard ratio, 0.44; 95 percent confidence interval, 0.34 to 0.59). Compared with warfarin, dabigatran 150 mg correlated with a significantly greater risk of gastrointestinal bleeding (1.23; 95 percent confidence interval, 1.01 to 1.50), which was potentiated in studies of older versus younger populations (median/mean age, ≥75 versus <75 years: β = 1.53; 95 percent confidence interval, 1.10 to 2.14).

"In real-world clinical practice, dabigatran is comparable with warfarin in preventing ischemic stroke among patients with nonvalvular atrial fibrillation," the authors write.

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