Topical issues of the efficiency and safety of using the first direct thrombin inhibitor in real clinical practice

• Main Author: A. V. Fonyakin
• Format: Article
• Language: Russian
• Published: IMA-PRESS LLC 2016-01-01
• Series: Nevrologiâ, Nejropsihiatriâ, Psihosomatika
• Subjects: atrial fibrillation; stroke; dabigatran; clinical practice
• Online Access: https://nnp.ima-press.net/nnp/article/view/568
• ISSN: 2074-2711; 2310-1342

A Regional Expert Council meeting was held in Moscow on August 21, 2015 to consider different aspects of the efficiency and safety of using the first direct thrombin inhibitor dabigatran etexilate in real clinical practice. The complex and debatable issues of prevention of systemic thromboembolic events in patients with non-valvular atrial fibrillation (AF) were the focus of attention. Five-year clinical use of dabigatran etexilate was noted to confirm its positive safety and efficacy profiles in real practice in more than 250,000 patients from nearly 100 countries of the world. The risk of ischemic stroke, intracerebral bleeding, and death was shown to be statistically significantly lower in the dabigatran group than in the warfarin group. The rate of major bleeding and myocardial infarction was comparable or even lower. An increased risk for bleeding was generally associated with undesirable drug interactions, polypragmasia, and underestimated kidney dysfunction. Renal function was recorded to decrease statistically less significantly in diabetic patients receiving dabigatran 150 mg twice daily than in those treated with warfarin. It was particularly emphasized that direct oral anticoagulants along with warfarin as fist-line agents might be used in patients with AF and acute coronary syndrome. It has been concluded that rich international experience with clinically used dabigatran provides support for a favorable benefit/risk ratio if all dosage guidelines are followed.