New anticoagulant therapy has fewer side-effects than warfarin

Faculty of 1000: Biology and MedicineSep 30 2009

In an article reviewed by F1000 Medicine Faculty Members Robert Ruff, Brian Olshansky and Luis Ruilope, the blood-thinner dabigatran is shown to protect against stroke, blood clotting and major bleeding as effectively as warfarin, but with fewer side effects.

The original paper, Dabigatran versus warfarin in patients with atrial fibrillation, by Neal Devaraj and Stuart Connolly et al. in the New England Journal of Medicine, says warfarin (also commonly used in rat poison) has several drawbacks. Finding the correct dosage requires careful and laborious monitoring, and the risk of major bleeding has led to it being under-used.

With fewer side-effects and complications than warfarin, the reviewers see many potential benefits from dabigatran. According to Olshansky, it is "perhaps one of the important drug discoveries in the past decade."

Ruilope says that according to the investigators, "This oral anticoagulant prevents strokes and peripheral embolic events in patients with atrial fibrillation significantly better than that much older drug (warfarin) at different doses. It is also safer than warfarin with respect to major bleeding events."

"An immediate change of practice is not warranted but a change in standard anticoagulant therapy may be needed," Ruilope says.