Real-world variability in dabigatran levels in patients with atrial fibrillation: comment

We read with interest the recent prospective observational study by Chan et al.[1] The authors aimed to investigate the inter- and intra-patient variability in dabigatran plasma levels with the 110 and 150 mg bid dose regimens in 100 patients suffering from atrial fibrillation (AF). They also assessed the effect of physicians' dose selection on plasma levels in the two different subgroups and explored whether a single trough measurement would identify patients with extreme plasma levels on subsequent visits, i.e. at 2-, 4- and 6-months [1]. They support the practice of selecting dabigatran dose based upon clinical characteristics because it results in similar levels of drug exposure in patients given the 110 or the 150 mg bid dose regimen. However, they do not support the concept that a single plasma level measurement with the Hemoclot Thrombin Inhibitor(®) (Hyphen BioMed) can be used to identify patients with consistently high or low plasma levels. This article is protected by copyright. All rights reserved.