New guidelines for atrial fibrillation management incorporate dabigatran

Key Points

An update on the management of atrial fibrillation (AF) issued by a task force consisting of the American College of Cardiology Foundation, the American Heart Association, and the Heart Rhythm Society has incorporated dabigatran into its recommendations.

The 2011 Focused Update on the Management of Patients with Atrial Fibrillation come shortly after dabigatran, an oral direct thrombin inhibitor with twice-daily dosing, was approved by FDA for the prevention of stroke in patients with nonvalvular AF. The Focused Update was published in Circulation: Journal of the American Heart Association, Journal of the American College of Cardiology, and HeartRhythm Journal.

According to the update, "Dabigatran is useful as an alternative to warfarin for the prevention of stroke and systemic thromboembolism in patients with paroxysmal to permanent AF and risk factors for stroke or systemic embolization who do not have a prosthetic heart valve or hemodynamically significant valve disease, severe renal failure (creatinine clearance <15 mL/min), or advanced liver disease (impaired baseline clotting function)."

The task force wrote that patients taking warfarin who already have an International Normalized Ratio (INR) within the therapeutic window may have little to gain by switching to dabigatran. "Selection of patients with AF and at least 1 additional risk factor for stroke who could benefit from treatment with dabigatran as opposed to warfarin should consider individual clinical features, including the ability to comply with twice-daily dosing, availability of an anticoagulation management program to sustain routine monitoring of INR, patient preferences, cost, and other factors," the task force wrote.

The RE-LY trial used a dosage of 110 mg twice daily, they noted, whereas the FDA-approved dosage is 150 mg twice daily (75 mg twice daily in patients with a creatinine clearance of 15 to 30 mL/min).

Dabigatran is the first new oral anticoagulant to become available in more than 50 years.