Dabigatran versus Warfarin in the Treatment of Acute Venous Thromboembolism

• Published in: The New England journal of medicine Vol. 361; no. 24; pp. 2342 - 2352
• Main Authors: Schulman, Sam, Kearon, Clive, Kakkar, Ajay K, Mismetti, Patrick, Schellong, Sebastian, Eriksson, Henry, Baanstra, David, Schnee, Janet, Goldhaber, Samuel Z
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 10.12.2009
• Subjects: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Benzimidazoles - adverse effects; Benzimidazoles - therapeutic use; Biological and medical sciences; Blood clots; Dabigatran; Double-Blind Method; Drug therapy; Female; General aspects; Heart attacks; Humans; International Normalized Ratio; Joint surgery; Life Sciences; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Pharmaceutical sciences; Pharmacology; Pulmonary arteries; Pyridines - adverse effects; Pyridines - therapeutic use; Recurrence; Risk; Tomography; Ultrasonic imaging; Veins & arteries; Venous Thromboembolism - drug therapy; Warfarin - adverse effects; Warfarin - therapeutic use; Young Adult; Warfarin; Serine endopeptidases; Enzyme; Coumarine derivatives; Acute; Enzyme inhibitor; Thrombin; Anticoagulant; Dabigatran; Antithrombin; Medicine; Antivitamin K; Peptidases; Antithrombotic agent; Hydrolases; Comparative study
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa0906598

In this comparative-effectiveness trial, the oral direct thrombin inhibitor dabigatran was shown to be as effective as warfarin in the prevention of recurrent venous thromboembolism. Bleeding complications were similar. Dabigatran therapy offers the advantage that monitoring of anticoagulation is not necessary. In this comparative-effectiveness trial, the oral direct thrombin inhibitor dabigatran was shown to be as effective as warfarin in the prevention of recurrent venous thromboembolism. Dabigatran therapy offers the advantage that monitoring of anticoagulation is not necessary. Venous thromboembolism affects 1 to 2 adults per 1000 annually and is the third most common cause of vascular death after myocardial infarction and stroke. 1 , 2 The current standard treatment is rapidly acting parenteral anticoagulation for 5 to 7 days followed by at least 3 months of treatment with a vitamin K antagonist. 3 Treatment with a vitamin K antagonist requires frequent monitoring of the international normalized ratio (INR), and multiple interactions of vitamin K antagonists with foods and other drugs have been reported. 4 Dabigatran etexilate (hereafter termed dabigatran) is an orally available, potent, direct inhibitor of thrombin. It is rapidly . . .