Dabigatran suitable alternative to warfarin in elective cardioversion
MedWire News: Results from the RE-LY study show that the oral direct thrombin inhibitor dabigatran has similar safety and efficacy to warfarin in atrial fibrillation (AF) patients undergoing cardioversion.
"The major finding of this study was that stroke and systemic embolism and major bleeding rates after cardioversion were low in both the dabigatran- and warfarin-assigned groups," report Michael Ezekowitz (The Heart Center, Wynnewood, Pennsylvania, USA) and team.
In the phase III RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) study, the researchers assessed the 30-day outcomes of 1270 patients who received dabigatran 110 mg (D110; n=647), dabigatran 150 mg (D150; n=672), or conventional warfarin (n=664) for 3 or more weeks prior to cardioversion.
In all, 1983 cardioversions were performed.
Cardioversion was preceded by transesophageal echocardiography (TEE) in 25.5%, 24.1%, and 13.3% of patients in the D110, D150, and warfarin groups, respectively, with a low rate (<2%) of left atrial thrombi detection by TEE in all groups.
The findings, reported in the journal Circulation, show similar 30-day rates of stroke and systemic embolism irrespective of type of anticoagulant used.
Specifically, patients in the D110, D150, and warfarin groups had respective stroke rates of 0.8%, 0.3%, and 0.6%; rates were similar in patients who did and did not have TEE before cardioversion.
This, say Ezekowitz and team, suggests "that cardioversion could be performed on patients on dabigatran regardless of the use of TEE."
Major bleeding rates were also low in all patients, although those taking dabigatran 110 mg had a nonsignificantly higher rate than patients taking dabigatran 150 mg or warfarin, at 1.7% versus 0.6% and 0.6%, respectively.
The researchers conclude: "The RE-LY trial confirmed the efficacy and safety of warfarin in cardioversion in a large cohort of warfarin-treated patients."
They add that dabigatran and warfarin "are comparable in this setting."
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By Lauretta Ihonor