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Dabigatran

Interaction
Two emerging anticoagulants look set to finally make significant in-roads into clinical practice in areas that have long been dominated by warfarin and enoxaparin.

Rivaroxaban is an oral agent that competitively and reversibly inhibits activated Factor Xa. Dabigatran is a competitive reversible antagonist of thrombin. While both appear to offer potential advantages over the current commonly-used anticoagulants such as warfarin and enoxoparin, the efficacy of the two drugs in relation to each other has not yet been tested.

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A joint initiative of the Patient Services Section and the Drug and Therapeutics Information Service of the Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia. The RGH Pharmacy E-Bulletin is distributed in electronic format on a weekly basis, and aims to present concise, factual information on issues of current interest in therapeutics, drug safety and cost-effective use of medications.
Editor: Assoc. Prof. Chris Alderman, University of South Australia – Director of Pharmacy, RGH © Pharmacy Department, Repatriation General Hospital, Daw Park, South Australia 5041.

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Warfarin has been shown in previous studies to prevent approximately 68% of strokes in atrial fibrillation, but close monitoring, drug and dietary interactions and risk of haemorrhage make it a difficult and inconvenient agent to use. Dabigatran is advantageous in many of these aspects, requiring comparatively little monitoring, having few drug interactions, being associated with an apparently decreased risk of intracranial haemorrhage relative to warfarin. Interaction

However, anticoagulation with dabigatran is non–reversible and the increased rate of gastrointestinal adverse effects is concerning. Futhermore, dabigatran appeared to be associated with an increased risk of myocardial infarction, a finding not adequately explained in this study.

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