Dabigatran demonstrates better safety than warfarin in stroke prevention
Essen/Ingelheim – Boehringer Ingelheim’s new anticoagulant dabigatran (Pradaxa) is as effective as warfarin in preventing stroke but has a lower risk of intracranial bleeding in patients with atrial fibrillation who have previously had a stroke or transient ischaemic attack, according to a new analysis of the pivotal RE-LY trial (Lancet Neurology, 7. Nov.). The data analysis of this subgroup by Hans-Christoph Diener from University Hospital Essen and colleagues, found that warfarin and both dosages of dabigatran were equally effective in preventing stroke or systemic embolism that occurred in 65 patients on warfarin compared with 55 on 110 mg dabigatran. The rate of major bleeding was significantly lower in patients on 110 mg dabigatran (RR 0,66, 95% CI 0,48-0,90) and similar in those on 150 mg dabigatran (RR 1,01; 95% CI 0,77-1,34) compared with those on warfarin. The 110 mg dose of dabigatran was also associated with a significant reduction in the rate of vascular death and all-cause mortality. According to the authors the mechanism that leads to the lower rate of intracranial bleeding remains unclear. One possible explanation is that dabigatran does not cross the blood–brain barrier.