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Dabigatran Prevents Secondary Stroke in Atrial Fibrillation

In this population, drug as effective as warfarin for stroke prevention without excess bleeding events

MONDAY, Nov. 8 (HealthDay News) -- The new anticoagulant dabigatran is as effective as warfarin for secondary stroke prevention in atrial fibrillation and does not have a higher bleeding risk, according to research published online Nov. 8 in The Lancet Neurology.

Hans-Christoph Diener, M.D., of the University Hospital Essen in Germany, and colleagues analyzed data from a subgroup of patients -- those with previous stroke or transient ischemic attack -- who were part of the Randomised Evaluation of Long-Term Anticoagulation Therapy trial. This trial showed that, compared with warfarin, dabigatran reduced occurrence of both stroke and hemorrhage in patients who had atrial fibrillation.

The researchers found that the relative risk (RR) of stroke or systemic embolism was 0.84 for patients on 110 mg dabigatran and 0.75 for patients on 150 mg dabigatran, compared to warfarin. Major bleeding was significantly lower in patients on 110 mg dabigatran (RR, 0.66), and similar in those on 150 mg dabigatran (RR, 1.01), compared with those on warfarin.

"In choosing the dose of dabigatran, physicians need to trade off the benefits of stroke prevention against the risk of hemorrhage. In general, strokes are more severe than are major hemorrhages and have more substantial long-term consequences," the authors write. "The dose of 150 mg dabigatran twice daily could be preferred to 110 mg twice daily because it significantly reduces the risk of ischemic stroke without increasing the risk of hemorrhagic stroke."

The study was supported by Boehringer Ingelheim; several of the study and editorial authors disclosed financial relationships with Boehringer Ingelheim and other pharmaceutical and/or medical device companies.

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