Dabigatran is an oral direct thrombin inhibitor with several advantages over warfarin: predictable anticoagulant effects, few food or drug interactions, rapid onset of action, and no laboratory monitoring / dose adjustments. Dabigatran was recently shown (in the RELY trial) to be superior to warfarin in reducing afib-related stroke (abstract). Now in the RECOVER trial, dabigatran proves its clinical equivalency for the treatment ofpatients with acute VTE. In this trial, 2539 patients with acute VTE (21% PE, 69% DVT, 10% both) were randomized to dabigatran 150mg BID vs warfarin (adjusted dose to INR 2-3) after a mean of 10 day of parenteral anticoagulation (IV heparin or LMWH). The 6-month rate of recurrent symptomatic VTE/related death was equivalent (about 2% in each group), with similar rates of major bleeding, ACD, death, and LFT abnormalities. Rates of any bleeding were actually higher in the warfarin group (22% vs 16%) (abstract). Despite it’s higher cost, given the benefits, dabigatran will likely start to replace warfarin for treatment of acute VTE.
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