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.
I am coming up on my two year anniversary. Not my wedding anniversary (soon to be 15 years – thanks Maia!), but two years since I joined the ranks of the patients. It was two years ago this week that my day was interrupted by a page from my internist saying, “I don’t know how […]
As you can see, no glamour shots for this month’s post. I knew it would come at some point, and my first hospitalization related to my CLL came in a big way in mid-July. Given my interest in global health, it was only fitting that I managed to get sick while out of the […]
This large multicenter trial randomized patients with acute VTE to apixaban (10mg BID for 1 week, followed by 5mg BID for 6 months) versus conventional therapy (lovenox-warfarin). The primary outcome was similar between groups (symptomatic VTE or death related to VTE), but major and minor bleeding occurred significantly less often with apixaban. Apixaban is a […]