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Alternative to warfarin could herald 'paradigm change' in AF treatment

By Nigel Praities

GPs could be in line for a ‘paradigm change' in their treatment of atrial fibrillation following positive trial results of the first credible alternative to warfarin to emerge in 50 years, cardiovascular experts are predicting.

A head-to-head comparison of warfarin and dabigatran - presented at the European Society of Cardiology conference and published online in the New England Journal of Medicine - showed the newer drug reduced major bleeding events and cut the risk of stroke by up to a third.

The results were greeted with excitement by cardiologists in Barcelona, who said the days of GPs conducting monthly INR checks for patients with atrial fibrillation could soon be over.

The Randomized Evaluation of Long-term anticoagulant therapy (RELY) trial compared usual care with warfarin and dabigatran twice daily in 18,000 patients

The 150mg dose of dabigatran significantly reduced the risk of stroke and systemic embolism by 34% more than warfarin. It also reduced the risk of a major bleed by 7%, although this was not statistically significant.

The 110mg dose of dabigatran reduced strokes by around the same as warfarin, but reduced the risk of a major bleed by 20% more than warfarin.

Professor John Camm, chair of cardiology at St George's Hospital Medical School, said: ‘We must regard this as a stimulus for a paradigm change in antithrombotic management of atrial fibrillation.'

Dabigatran is currently unlicensed for AF, but is indicated for the prevention of venous thrombosis in patients following hip and knee replacement surgery. Manufacturer Boehringer Ingelheim is expected to apply for a widening of the license.

Dr Kathryn Griffith, president elect of the Primary Care Cardiovascular Society, said: ‘It is an exciting time, because warfarin is a pain to manage.'

Dabigatran is the first credible alternative to warfarin to emerge in 50 years, experts believe Dabigatran is the first credible alternative to warfarin to emerge in 50 years, experts believe

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