Key result
In a multicenter registry of 78 patients with atrial fibrillation and recent stroke or TIA, dabigatran treatment resulted in no recurrent ischemic events and a 2.6% rate of major hemorrhage over a mean follow-up of 7 months.
Cohort (n=78)
Yes
In a small, real-world registry of AF patients with recent stroke or TIA, early initiation of dabigatran was safe with no recurrent ischemic events or intracranial hemorrhages, though high cost led to frequent discontinuation.
May support early dabigatran after stroke/TIA in AF; hypothesis-generating and leaves open confirmation in randomized trials.
BACKGROUND: There are growing concerns for the side effects of dabigatran etexilate (dabigatran), including higher incidence of dyspepsia and gastrointestinal bleeding. We conducted a multicenter early implementation study to prospectively evaluate the safety, efficacy and adherence to dabigatran for secondary stroke prevention. METHODS: Consecutive atrial fibrillation (AF) patients with ischemic stroke (IS) or transient ischemic attack (TIA) received dabigatran for secondary stroke prevention during their hospital stay according to American Heart Association recommendations at five tertiary care stroke centers. The study population was prospectively followed and outcomes were documented. The primary and secondary safety outcomes were major hemorrhage and all other bleeding events respectively defined according to RE-LY trial methodology. RESULTS: A total of 78 AF patients (mean age 71 ± 9years; 54% men; 81% IS, 19% TIA; median CHADS2 (Congestive heart failure, Hypertension, diabetes mellitus, age >75 years, prior stroke or TIA); range 2-5) score 4 were treated with dabigatran [(110mg bid (74%); 150mg bid (26%)]. During a mean follow-up period of 7 ± 5 months (range 1-18) we documented no cases of IS, TIA, intracranial hemorrhage, systemic embolism or myocardial infarction in AF patients treated with dabigatran. There were two (2.6%) major bleeding events (lower gastrointestinal bleeding) and two (2.6%) minor bleedings [hematuria (n = 1) and rectal bleeding (n = 1)]. Dabigatran was discontinued in 26% of the study population with high cost being the most common reason for discontinuation (50%). DISCUSSION: Our pilot data indicate that dabigatran appears to be safe for secondary stroke prevention during the first year of implementation of this therapy. However, high cost may limit the long-term treatment of AF patients with dabigatran, leading to early discontinuation.
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Tsivgoulis et al. (2014) conducted a cohort in Atrial fibrillation with ischemic stroke or transient ischemic attack (n=78). Dabigatran etexilate was evaluated on Major hemorrhage. In a multicenter registry of 78 patients with atrial fibrillation and recent stroke or TIA, dabigatran treatment resulted in no recurrent ischemic events and a 2.6% rate of major hemorrhage over a mean follow-up of 7 months.
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