Dabigatran as anticoagulant therapy for atrial fibrillation. Which patients should receive it, which patients may not need it, and other practical aspects of patient management

In the past decade, antithrombotic therapy research has focused on the development of new oral anticoagulant drugs to replace vitamin K antagonists for stroke prevention in patients with chronic atrial fibrillation, for preventing cardiovascular complications of acute coronary syndromes, and for the prevention and treatment of venous thromboembolism. The most anticipated studies relate to the use of new oral anticoagulants to replace vitamin K antagonists for the prevention of stroke in patients with atrial fibrillation. This review will focus on dabigatran, the first non-vitamin K anticoagulant approved for this clinical indication, and will assess the RE-LY trial (Randomized Evaluation of Long Term Anticoagulant Therapy) findings according to the level of anticoagulation control in warfarin-treated patients. The objectives of this review are: 1) to provide an overview of dabigatran, highlighting clinically relevant properties; 2) to provide a commentary on the study by Wallentin et al. within the context of how the quality of anticoagulation control affects warfarin efficacy and safety; and 3) to consider which patients with chronic atrial fibrillation should receive and which may not need to receive dabigatran.