A 75 year old male presents to his GP with a complaint of palpitations. An EKG reveals that he is in atrial fibrillation. He is on a thiazide for hypertension but no other medications. Based on his CHADS-2 score, he would be a candidate for anti-coagulation to prevent stroke. What options would be available for someone in his circumstance?
The approved medications in Canada for non-valvular atrial fibrillation include warfarin to achieve a target INR between 2-3 and dabigatran at a dose of 150 mg p.o. bid. The largest trial (RE-LY) comparing Dabigatran to Warfarin was a double blinded non-inferiority RCT comparing these two dosing strategies in over 18,000 patients. The median duration of follow-up was 2.0 years with the primary outcomes being stroke or systemic embolism. The rates of stroke and VTE were similar between both arms, however there was a statistically lower rater of major bleeding an hemorrhagic stroke.
Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361:1139.