Warfarin Vs dabigatran - Essay Example

Any discrepancy in diet mediated intensity of vitamin K, directly influences the efficacy and dose dependency of Warfarin for the patient. It is essential to determine appropriate therapeutic dosages on individual basis by means of standardized clotting test (international normalized ratio [INR]). Although, Warfarin potentially diminishes the risk of stroke in AF patients by ~ 68%, patient compliance with treatment (time in therapeutic range [TTR]) is a noteworthy predicament because of the essential periodic supervision of dose efficacy and the risk of major bleeding events (Ezekowitz, 2007).

On the contrary, Dabigatran does not entail labor and time intensive monitoring and therefore expected to provide enhanced patient compliance over Warfarin. Atrial fibrillation is asymptomatic and generally not life-threatening. It augments the risk of stroke as well as systemic embolisms as the upper chambers of the heart begin to beat irregularly, impairing the efficiency of blood flow. Symptoms found to be associated encompass rapid heart rate, palpitation, shortness of breath, dizziness, faint or fatigue.

Reduced flow of blood results in blood pooling in the heart chambers which may culminate into clot formation. When such clots enter the brain it results in stroke, it is therefore essential for physicians to prescribe anticoagulants to prevent formation of clots. The prevalence of AF in the United States display augmentation from < 1% for individuals under 60 and >10% for individuals above 80 (Centers for Disease Control and Prevention [CDC], 2003). Deaths associated to AF affect 1 in 4000 cases per year, of these, 84% cases are reported to be above 75.

Warfarin was drug of choice for past decades as an effective oral anticoagulant to prevent and treat thromboembolism. Over the years researchers were constantly trying to relieve patients from troubles related to diet and drug interactions. Three randomized, controlled trials are available on the safety and efficacy of Dabigatran, they are summarized below- Atrial fibrillation patients frequently suffer from coronary artery disease, which is the focus of a Dabigatran phase II clinical trial, to establish its safety in combination with aspirin (Ezekowitz et al., 2007). Three Dabigatran doses (50, 150, and 300 mg) were administered twice daily to patients for 12 weeks, unaided or in combination with 81 or 325 mg aspirin, thereby generating nine experimental groups.

The patients treated with Warfarin (INR = 2.0-3.0) were used as a control. The primary outcome of concern was bleeding events encompassing major (6% increase, p < 0.02) or all sorts of bleeding events (26% increase, p = 0.0003), that was reported in patients treated with 300 mg Dabigatran twice a day along with aspirin. On the other hand, 50 mg Dabigatran was less likely to cause bleeding as compared to other conditions (15% increase vs. 300 mg p = 0.0002; 11% increase vs. 150 mg p = 0.01; 11% increase vs.

Warfarin, p = 0.044). On the contrary, two embolisms reported in the study were from the cases taking 50 mg Dabigatran twice daily, unaided or accompanied by 81 mg aspirin. On the other hand result indicates that 50 mg Dabigatran, with or without 81 mg aspirin, does not accomplish successful shielding against stroke or systemic embolisms. This possibility was sustained by finding