Dabigatran bij voorkamerfibrillatie: Klinische studies, voordelen en beperkingen

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, especially in older people. This condition is associated with an increased risk of stroke, and long term anticoagulation treatment is therefore needed Vitamin K antagonists are effective in reducing the risk of stroke but optimal use of these drugs remains difficult. The development of new oral anticoagulant drugs is therefore highly relevant. Dabigatran is an oral direct thrombin inhibitor. Its prodrug, dabigatran etexilate, is marketed under the name of Pradaxa® and was initially approved for the prevention of thromboembolic events in major orthopedic surgery. It has been recently approved for stroke prevention in patients with atrial fibrillation. The purpose of this paper is to review - in light of current knowledge - the interests and limits of using dabigatran etexilate in atrial fibrillation. Briefly, dabigatran etexilate is not inferior to warfarin in atrial fibrillation. However many questions remain unanswered, including questions related to the concomitant use of dabigatran etexilate and acetylsalicylic acid, the possible increased risk of myocardial infarction and the need for drug monitoring.