Abstract WMP99: Dabigatran: How Does It Fare In The Real World? Mayo Clinic And Regional Experience With A Novel Anticoagulant.
Background: Although not without its limitations, warfarin has provided essential protection against cardioembolic stroke in nonvalvular atrial fibrillation (NVAF) for over 60 years. Dabigatran, the first oral direct thrombin inhibitor to be approved in the United States is reputed to provide the same or better ischemic stroke protection with reduced risk of intracranial hemorrhage. However, it remains to be seen whether its promise will be borne out in everyday practice.
Objective: Track initial dabigatran course in patients at Mayo Clinic Arizona and regional stroke centers since its approval in 2010.
Methods: Retrospective chart review of all dabigatran patients between October 2010 and September 2011. Regional practices were obtained from a nationwide survey of cardiologists and neurologists.
Results: See table
Conclusion: During our period of review, dabigatran was well tolerated. A smaller than expected number of patients discontinued the agent or experienced adverse events, as compared to randomized controlled trial predictions. Furthermore, rates of ischemic events (2/159 or 1.26%) were exceedingly low. Our study had several limitations (retrospective review; random bias, sample bias with low numbers and a more elderly population, shorter median follow up). Many of these shortcomings could be addressed with prospective patient tracking. As with any novel therapy, provider surveys afforded an important window into real world practices and perceptions regarding dabigatran. The majority believed it was a reasonable alternative to warfarin, citing fluctuating INR’s as the most persuasive target population followed by patient preference. Cost was an important limiting factor to prescription and considerable uncertainty remains surrounding reversibility and how to approach acute thrombolysis in recurrent ischemic stroke.
- © 2012 by American Heart Association, Inc.