Abstract

Daily practice data of Dabigatran etexilate anticoagulation treatment in Nonvalvular AF

Stroke prevention

Hendro Susilo
Dept Neurology
DrSoetomo Hospital
Surabaya

Atrial fibrillation (AF) play an important role as a risk factor for stroke and it accounts for
more than 20% of all ischemic stroke and patients with AF showed five fold higher risk of
ischemic stroke. Little is known about the impact of anticoagulation control as reflected by
time in therapeutic range (TTR) of warfarin therapy especially in Asian population. Although
warfarin therapy with target international normalized ratio (INR) between 2.0 and 3.0 has
been shown effective in reducing ischemic stroke and mortality among patients with non
valvular AF, its benefit could be offset by the increased intracranial hemorrhage (ICH)
related with the therapy. This is of particular relevance to Asian population such as the
Chinese that demonstrate higher baseline risk of ICH thus undermining the potential benefit
of any antithrombotic therapy. This medical fact maybe one of underutilization of warfarin
therapy and the high prevalence of aspirin therapy in these population. TTR has emerged as a
marker reflecting the quality of anticoagulation control while on vitamin K antagonist
warfarin and the TTR has been shown to be closely correlated with ischemic stroke,
hemorrhage and mortality. Dabigatran etexilateis a competitive direct thrombin inhibitor to
reduce the risk of stroke and systemic embolization in patients with nonvalvular AF.In a large
cohort of elderly Medicare beneficiaries with NVAF study in general practice settings
dabigatran was associated with reduced ischemic stroke, intracranial hemorrhage and death
and increased risk of major gastrointestinal hemorrhage compared with warfarin. These
association were strongest for the 150 mg dabigatran dose , whereas the 75 mg dose was
associated only with reduced risk of intracranial hemorrhage. As with other non vitamin K
oral anticoagulant approved for stroke prevention dabigatran 150 mg twice daily was
associated with less intracranial hemorrhage and major extracranial bleeding including GI
bleeding compared with factor Xa inhibitor rivaroxaban 20 mg once daily
treatment.Predictive factors of intracranial hemorrhage such as age of more than 75 years,
prior ICH, hypertension, diabetes mellitus, TTR in the lowest quartile should be considered
for the safety in various anticoagulation treatment.

Keywords : Nonvalvular AF – vitamin K antagonist – Dabigatran efficacy and safety