TDNet Discover

Background: The anticoagulant warfarin has been utilized in medicine for 59 years and is indicated for conditions including nonvalvular atrial fibrillation (Afib). Afib predisposes patients to be at high risk for thromboembolism and consequently ischemic strokes. Warfarin remains the most prescribed pharmaceutical agent to prevent complications of coagulation, despite the recently introduced competitor, dabigatran (Barnes, Lucas, Alexander, & Goldberger, 2015). Dabigatran is a novel oral anticoagulant of eight years that uses a different mechanism of action and avoids common complications that patients prescribed warfarin often face. Objective: The objective of this study is to ask if dabigatran is more effective than warfarin, the current standard of practice, in preventing thromboembolic disease in patients who are undergoing anticoagulation therapy for nonvalvular atrial fibrillation. Methods: Literature Search was conducted in November 2017. Results: Three main studies were analyzed. The first was a cohort study with population of 134,414 Medicare patients over 65 years of age who filled a prescription for dabigatran or warfarin from October 19, 2010 through December 31, 2012. The second study, a randomized control trial with population of 42,952, consisted of random Medicare recipients who were newly diagnosed with Afib during the time interval from January 1, 2013 to December 31, 2014.The third study, a retrospective observational cohort study with population of 26,647, required participants to be age 18 and older who were newly diagnosed with Afib and who were OAC naïve between October 2009 and October 2012. Conclusion: Dabigatran improves patient mortality and decreases incidence of intracranial hemorrhage compared to warfarin in patients with nonvalvular atrial fibrillation. By offering the same benefit as warfarin, with fewer routine laboratory requirements, dabigatran is the superior option for anticoagulation therapy in nonvalvular atrial fibrillation. The dabigatran regimen is less complex than warfarin and does not require INR monitoring or dietary restrictions. Dabigatran has the potential to improve anticoagulant therapy compliance, indicating superiority.