Thursday, July 11, 2013


Dabigatran has been with us a few years now. Marketed by Boeringher I, for stroke reduction in atrial fibrillation and also deep venous thrombosis, it has been fairly freely used in Malaysia. Though expensive ( when compared to warfarin ), Boeringher has managed to get it into the blue book or MOH, and I see patients coming to me, with supplies of Dabigatran from MOH hospitals. Rememberng that Dabigatran is expensive. Much more so than warfarin.
I have never had much problem with warfarin, though I see a fair amount of patients with chronic arial fibrillation and also patients with mechanical valve replacements. It is cheap, effective and safe ( when use properly ).
Recently there have been more publications warning of the dangers of dabigatran.
In the just concluded annual scientific meeting of the International Society of Thrombosis and Hemostasis, in Amsterdam, Dr J Douxfils of the University of Namur, Belgium, presented a meta-analysis of 10 trials of patients on dabigatran for atrial fibrillation. The meta- analysis included about 23,839 patients on the different doses of dabigatran and also those on dabigatran compared to placebo and warfarin. They found that those on dabigatran had a 32% increase in MIs and this risk seem to be dose related, worse with the higher doses.

In the 26th June issue of the Journal of the American College of Cardiology, Dr Iike Sapahi from the Case Medical Center, Cleveland Ohio, published meta-analysis, in a letter to the editor. They reviewed all the published clinical data on dabigatran publishes till date, and compared them to warfarin and placebo. They also showed a 48% increase in MI rates in those patients taking danigatran for venous thrombosis and acute coronary syndromes.

Now, obviously meta-analysis are never confirmatory, but it does show a worrying trend, that we should take note of, especially those of us taking care of patients at risk of MIs.
We should await more data before concluding, but the trend is worrying.
Warfarin for all her sins, may yet prove to be the better choice. It is also cheap.

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