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Dabigatran increases coronary risk ‘more than other newer anticoagulants’

Dabigatran is associated with a higher risk of coronary events than other newer anticoagulants, concludes a new meta-analysis.

The analysis looked at 28 randomised controlled trials involving 138,948 patients with four recently developed alternative treatments to warfarin: ximelagatran, dabigatran, rivaroxaban and apixaban.

The trials were selected based on whether they mentioned the occurrence of acute coronary events or all-cause mortality and if they comprised at least 1,000 subjects.

They found that, compared with the control group, the risk of acute coronary events such as myocardial infarction and acute coronary syndrome rose significantly by 30% in the groups using dabigatran.

In contrast, ximelagatran was associated with a 65% increased likelihood for coronary events which although greater than for dabigatran, was found not to be statistically significant. The risk associated with rivaroxaban and apixaban decreased by 22% and 6% respectively, compared with controls.

The authors from The Mak Heart Clinic in Singapore, concluded: ‘These findings were instructive in providing insight on the relative occurrence adverse cardiovascular events impacting on the choice of these agents in specific patient subsets requiring anticoagulation.’

Dr Terry McCormack, a GP in Whitby, north Yorkshire, and co-editor of the British Journal of Cardiology, said: ‘We already knew there was a higher incidence of myocardial infarctions [with dabigatran], but the feeling was that this was offset by the reduction in strokes.

‘All the trials had significantly different approaches to warfarin comparison and side effect recording and it is difficult to compare them. I am using both dabigatran and rivaroxaban and for now I will continue to use both.’

A spokesperson from the manufacturer of dabigatran, Boehringer Ingelheim, said the analysis was only from a ‘restricted data set’.

He said: ‘The totality of evaluated study data, as well as the most recent post-hoc analysis from the largest study of Pradaxa [dabigatran] continues to support the conclusion that myocardial infarction is not an adverse consequence of the administration of Pradaxa.’

BMJ Open, online 6 October

http://bmjopen.bmj.com/content/2/5/e001592.abstract

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