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.
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.