Comparative Effectiveness of Dabigatran, Rivaroxaban, Apixaban, and Warfarin in the Management of Patients With Nonvalvular Atrial Fibrillation

Nature: 6/5/13

Atrial fibrillation (AF) is estimated to affect 2.5 million people in the United States, and results in a fivefold increase in the risk of ischemic stroke.^1,2 The associated costs exceed$7 billion annually.³ Antithrombotic agents have proven benefits in preventing stroke in AF patients. Until recently, vitamin K antagonists such as warfarin were the only form of oral thromboprophylactic anticoagulation treatment.⁴ Although clinically effective and inexpensive, warfarin increases the risk of hemorrhage, interacts with many drugs, and, because of the considerable variability in patient response, requires careful monitoring.^5,6

Newer oral anticoagulants, which include the direct thrombin inhibitor dabigatran etexilate (hereafter referred to as dabigatran) and the direct factor Xa inhibitors rivaroxaban and apixaban, have recently been developed. The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) study evaluated two doses (110 and 150 mg twice daily) of dabigatran as an alternative to warfarin in 18,113 patients with at least one risk factor for stroke. Read more