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ESC: Dabigatran May Beat Warfarin in Atrial Fibrillation

Last Updated: August 31, 2009.

 

But warfarin may increase risk of stroke in atrial fibrillation patients with renal disease

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In atrial fibrillation patients, dabigatran may reduce the risk of stroke or systemic embolism more effectively than warfarin, according to a study published online Aug. 30 in the New England Journal of Medicine and presented at the European Society of Cardiology Congress 2009, held from Aug. 29 to Sept. 2 in Barcelona, Spain. Another study, published Aug. 27 in the Journal of the American Society of Nephrology, concludes that warfarin may increase the risk of stroke in atrial fibrillation patients who also have end-stage renal disease.

MONDAY, Aug. 31 (HealthDay News) -- In atrial fibrillation patients, dabigatran may reduce the risk of stroke or systemic embolism more effectively than warfarin, according to a study published online Aug. 30 in the New England Journal of Medicine and presented at the European Society of Cardiology Congress 2009, held from Aug. 29 to Sept. 2 in Barcelona, Spain. Another study, published Aug. 27 in the Journal of the American Society of Nephrology, concludes that warfarin may increase the risk of stroke in atrial fibrillation patients who also have end-stage renal disease.

In the NEJM study, Stuart J. Connolly, M.D., of McMaster University in Hamilton, Canada, and colleagues randomly assigned 18,113 atrial fibrillation patients to receive either fixed doses of dabigatran or an adjusted-dose of warfarin for a median of two years. The dabigatran group, who took 150 mg twice daily, had a significantly lower rate of systemic embolism or stroke compared to those who took either dabigatran at a dose of 110 mg or warfarin. They also found that 150 mg of dabigatran was associated with a lower rate of non-hemorrhagic stroke than either 110 mg of dabigatran or warfarin.

In the JASN study, Kevin E. Chan, M.D., of Fresenius Medical Care N.A. in Waltham, Mass., and colleagues studied 1,671 hemodialysis patients with atrial fibrillation at baseline, and followed them for an average of 1.6 years from initiation of dialysis. The researchers found that patients who used warfarin had a higher risk of new stroke compared with those who did not use the drug, but there was no such increased risk associated with clopidogrel or aspirin.

"In conclusion, warfarin use among patients with both end-stage renal disease and atrial fibrillation associates with an increased risk for stroke. The risk is greatest in warfarin users who do not receive in-facility international normalized ratio monitoring," Chan and colleagues write.

The NEJM study was supported by Boehringer Ingelheim; several authors reported financial relationships with Boehringer Ingelheim.

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