This guideline lays out the criteria for the use of Dabigatran, a thrombin inhibitor.
It can be considered as an alternative to warfarin in non-valvular AF if at least one of the following applies:
- Previous CVA / TIA / systemic embolism
- LV ejection fraction < 40%
- Heart Failure NYHA II or above
- ≥ 75
- ≥ 65 + DM or coronary artery disease or hypertension
It is much more expensive than warfarin, though at higher doses is more effective at reducing stroke. Its major benefits are in not having so many food and drug interactions and not needing monitoring. We will need to wait to see how this will be used locally.
Apart from cost, the main downside was that there was more major GI bleeding than with warfarin.