Warfarin versus dabigatran etexilate: an assessment of efficacy and safety in patients with atrial fibrillation

Abstract

Introduction Oral anticoagulation is the mainstay for stroke and thromboembolic events prevention in patients with atrial fibrillation (AF). Given limitations of warfarin therapy non-vitamin K oral anticoagulants have been developed, including direct thrombin inhibitors (i.e. dabigatran etexilate). Dabigatran etexilate has been tested thoroughly in terms of efficacy and safety in clinical trials and studies, involving 'real world' cohorts. In this review currently available evidence in patients with non-valvular AF is discussed. Areas covered The pharmacology, efficacy and safety, and current aspects of use of dabigatran etexilate in patients with non-valvular AF are reviewed in comparative manner to warfarin both for chronic anticoagulation and in different clinical settings. Expert opinion Dabigatran etexilate appeared to have several pharmacokinetic and pharmacodynamic advantages over warfarin as well as a favourable efficacy and safety profile being at least non-inferior and often superior to warfarin in patients with non-valvular AF. The latter was shown in the clinical trials, meta-analyses and studies with 'real world' data. Currently ongoing trials will expand the body of evidence on warfarin and will aid decision-making in currently controversial areas. Important limitations of dabigatran etexilate include contraindications for its use in patients with prosthetic heart valves and end-stage chronic kidney disease.