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Original Article Dabigatran versus Warfarin in Patients with Atrial Fibrillation Stuart J. Connolly, M.D., Michael D. Ezekowitz, M.B., Ch.B., D.Phil., Salim Yusuf, F.R.C.P.C., D.Phil., John Eikelboom, M.D., Jonas Oldgren, M.D., Ph.D., Amit Parekh, M.D., Janice Pogue, M.Sc., Paul A. Reilly, Ph.D., Ellison Themeles, B.A., Jeanne Varrone, M.D., Susan Wang, Ph.D., Marco Alings, M.D., Ph.D., Denis Xavier, M.D., Jun Zhu, M.D., Rafael Diaz, M.D., Basil S. Lewis, M.D., Harald Darius, M.D., Hans-Christoph Diener, M.D., Ph.D., Campbell D. Joyner, M.D., Lars Wallentin, M.D., Ph.D., and the RE-LY Steering Committee and Investigators N Engl J Med 2009; 361:1139-1151 DOI: 10.1056/NEJMoa0905561.

Results Rates of the primary outcome were 1.69% per year in the warfarin group, as compared with 1.53% per year in the group that received 110 mg of dabigatran (relative risk with dabigatran, 0.91; 95% confidence interval [CI], 0.74 to 1.11; P. Figure 2 Relative Risk of the Primary Outcome of Stroke or Systemic Embolism with Dabigatran versus Warfarin, According to Subgroup. Ethnic group was self-reported.

Long-term therapy with a vitamin K antagonist (VKA) denotes a total lifetime use of a VKA of 61 days or more. The body-mass index is the weight in kilograms divided by the square of the height in meters.

The CHADS 2 score is a measure of the risk of stroke in which congestive heart failure, hypertension, an age of 75 years or older, and diabetes mellitus are each assigned 1 point and previous stroke or transient ischemic attack is assigned 2 points; the score is calculated by summing all the points for a given patient. Creatinine clearance was calculated according to the Cockcroft–Gault method. The squares with horizontal lines are hazard ratios and corresponding 95% confidence intervals; the sizes of squares are proportional to the sizes of the subgroups. PPI denotes proton-pump inhibitor. Atrial fibrillation increases the risks of stroke and death.

Vitamin K antagonists, such as warfarin, reduce the risks of stroke and death but increase the risk of hemorrhage as compared with control therapy. Download Game Nuoi Ca De Tien Full. Therefore, warfarin is recommended for patients who have atrial fibrillation and are at risk for stroke.

Vitamin K antagonists are cumbersome to use, because of their multiple interactions with food and drugs, and they require frequent laboratory monitoring. Therefore, they are often not used, and when they are, rates of discontinuation are high. Many patients receiving warfarin still have inadequate anticoagulation. Thus, there is a need for new anticoagulant agents that are effective, safe, and convenient to use. Winchess Download Free there. Dabigatran etexilate is an oral prodrug that is rapidly converted by a serum esterase to dabigatran, a potent, direct, competitive inhibitor of thrombin. It has an absolute bioavailability of 6.5%, 80% of the given dose is excreted by the kidneys, its serum half-life is 12 to 17 hours, and it does not require regular monitoring. Dabigatran has been evaluated in a pilot trial involving patients with atrial fibrillation and in a study for the prevention of venous thromboembolism, in which doses of 150 mg twice daily and 220 mg once daily, respectively, were promising.

We performed a large, randomized trial comparing the use of dabigatran, at doses of 110 mg twice daily and 150 mg twice daily, with warfarin. Trial Design The Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) was a randomized trial designed to compare two fixed doses of dabigatran, each administered in a blinded manner, with open-label use of warfarin in patients who had atrial fibrillation and were at increased risk for stroke.