For an Appointment call: 201. 996. 2997

Recommendations for Anticoagulation

We now for the first time have an alternate to warfarin. Dabigatran, a direct inhibitor of thrombin, was recently approved for the treatment of patients who need anticoagulation and have a non-valvular cause for atrial fibrillation. In the RE-LY study patients on 150 mg of dabigatran taken twice a day had a lower incidence of stroke and other blood clotting events compared to patients on warfarin. The overall risk of bleeding was approximately the same with a slightly lower incidence of intracranial hemorrhage and a slightly higher incidence of extracranial (mostly GI) bleeding in patients taking Dabigatran. The advantages of Dabigatran are: the onset of action is rapid, the dosing is fixed, there is no interaction with food, there are few drug interactions, no monitoring is required, and the drug has a short half-life. One potential disadvantage is there is no antidote for Dabigatran. The dose of Dabigatran is 150 mg twice daily with a creatinine clearance above 30 ml/min, and a dose of 75 mg twice a day with a creatinine clearance of 15 – 30 ml /min.

So which patient would not be a candidate for Dabigatran? Patients who are stable on warfarin; with a creatinine clearance of less than 15 ml/min; with severe hepatic dysfunction; with a high risk of GI bleeding; with a mechanical valve.

If your physician would like to refer you for a consultation or you would like to make an appointment to speak with us concerning the treatment options available to you in our Atrial Fibrillation Center please call (201) 996-2997.

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