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Dabigatran etexilate for stroke prevention in patients with atrial fibrillation: Resolving uncertainties in routine practice

Journal: Thrombosis and Haemostasis
ISSN: 0340-6245
DOI: http://dx.doi.org/10.1160/TH11-10-0718
Issue: 2012: 107/5(May) pp. 803-1007
Pages: 838-847

Dabigatran etexilate for stroke prevention in patients with atrial fibrillation: Resolving uncertainties in routine practice

M. V. Huisman (1), G. Y. H. Lip (2), H.-C. Diener (3), M. Brueckmann (4), J. van Ryn (5), A. Clemens (4)

(1) Departments of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands; (2) University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK; (3) Department of Neurology, University Hospital Essen, Essen, Germany; (4) Global Clinical Development and Medical Affairs, Boehringer Ingelheim GmbH & Co. KG, Ingelheim, Germany; (5) Department of CardioMetabolic Disease Research, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany

Keywords

Atrial fibrillation, bleeding, oral anticoagulant, dabigatran

Summary

Dabigatran etexilate is a new oral anticoagulant recently approved in Europe for the prevention of stroke or systemic embolism in adult patients with non-valvular atrial fibrillation (AF) and at least one risk factor for stroke. With a fast onset of action and a predictable anticoagulant effect obviating the need for coagulation monitoring, dabigatran etexilate offers practical advantages over vitamin K antagonists in clinical practice. However, clinicians may have questions about practical aspects of dabigatran etexilate use including monitoring anticoagulant efficacy, interruption for surgical or invasive procedures and management of bleeding. This review article aims to address these concerns and provide guidance on the use of dabigatran etexilate in special situations, such as acute coronary syndromes and cardiac revascularisation. In addition, cut-off values for different coagulation assay results associated with an increased risk of bleeding are given.

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