Dabigatran Compared with Warfarin for Stroke Prevention in Patients with Atrial Fibrillation: An Evidence Based Case Report
Abstract: Atrial fibrillation
(AF) increases the risk of having stroke as high as five fold. Anticoagulant
administration such as vitamin K antagonist has been used regularly to reduce
the occurence of stroke. Despite the high
efficacy, warfarin has several limitations, including a narrow
therapeutic window, multiple food and drug interactions, and the need for
frequent laboratory monitoring. Dabigatran, an oral thrombin inhibitor,
displays some positive characteristics
as the solution to warfarin’s limitations. Aim. To determine the efficacy of
dabigatran compared to warfarin for stroke prevention in patients with atrial
fibrillation.Methods. A search was conducted on PubMed and Google. The
selection of title and abstract was done using inclusion and exclusion
criteria. Five original articles were found, but only one study was used. The
selected study was critically appraised for its validity, importance and
applicability. Result. The administration of 150 mg of dabigatran was superior
to warfarin with respect of stroke. The relative risk reduction was 36% in the
150 mg dabigatran group. The rate of stroke was 1.01% per year in the group
that received 150 mg dabigatran, as compared with 1.57% per year in the
warfarin group (relative risk 0.64; 95% confidence interval, 0.51 to 0.81,
p<0.001). The administration of dabigatran increased the risk of gastrointestinal
bleeding.Conclusion. In patients with atrial fibrillation, dabigatran given at
a dose of 150 mg, as compared with warfarin, was associated with lower rate of
stroke. Dabigatran administration requires closed gastrointestinal monitoring.
Author: Alvin Nursalim, Yoga
Yuniadi
Journal Code: jpkedokterangg110222
