2种剂量达比加群应用于房颤的获益和风险评估(华法林对照)

Balancing the benefits and risks of two doses of Dabigatran compared with Warfarin in Atrial Fibrillation
作者:Eikelboom JW, Connolly SJ, Hart RG, Wallentin L, R
期刊: J AM COLL CARDIOL2013年6月期卷

OBJECTIVE:

The primary objective was to compare the net clinical benefit of dabigatran 110mg bid and 150mg bid with that of warfarin in patients with atrial fibrillation (AF).

BACKGROUND:

In patients with AF, dabigatran 110mg bid and 150mg bid are associated with similar rates of death. However, the higher dose reduces ischemic stroke and increases bleeding compared with the lower dose. Therefore, there is uncertainty about how to evaluate the overall benefit of the two doses.

METHODS:

In 18,113 AF patients in RE-LY, we used a previously developed method for integrating ischemic and bleeding events as "ischemic stroke equivalents" in order to compare a weighted benefit of two doses of dabigatran with each other, and with that of warfarin.

RESULTS:

Compared with warfarin, there was a significant decrease in ischemic stroke equivalents with both dabigatran doses: -0.92 per 100 patient years (95% CI: -1.74 to -0.21, p=0.02) with dabigatran 110mg bid and -1.08 (95% CI: -1.86 to -0.34, p=0.01) with dabigatran 150mg bid. There was no significant difference in ischemic stroke equivalents between the two doses: -0.16 (95% CI: -0.80 to 0.43) comparing dabigatran 150mg bid with 110 bid. When including death in the weighted benefit calculations, the results were similar.

CONCLUSION:

On a group level both doses of dabigatran as compared with warfarin have similar benefits when considering a weighted estimate including both efficacy and safety. The similar overall benefits of the two doses of dabigatran versus warfarin support individualizing the dose based on patient characteristics and physician and patient preferences.

学科代码:心血管病学   关键词:Dabigatran Warfarin Atrial Fibrillation
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