Daily Archive 06.02.2019

Thrombin inhibitors for atrial fibrillation (AF)

It was shown that dabigatran in a dose of 150 mg 2 times a day is more effective in preventing ischemic stroke than warfarin, and in a dose of 110 mg 2 times a day is not inferior to warfarin in effectiveness. Unlike warfarin, therapeutic levels of the drug are observed already 2 h after administration, and the state of stable equilibrium plasma concentration is reached within 2 days. Dabigatran is excreted primarily by the kidneys and is therefore contraindicated for severely impaired renal function or continued massive bleeding.

The dose of the drug should be reduced to 110 mg 2 times a day if the patient is over 80 years old or if the patient is receiving verapamil or when a high risk of bleeding is assumed. In moderate renal insufficiency, the drug is recommended to be administered at a dose of 75 mg 2 times a day.

In the UK, according to the latest changes in recommendations, it is allowed to use new oral anticoagulants (such as dabigatran) after talking with the patient about the advantages and disadvantages of these drugs compared to warfarin. However, these recommendations do not apply to women aged 65-74 without other cardiovascular risk factors that have up to 2 points inclusive on the CHA2DS2VASc scale.

The main adverse effects are relatively rare dyspeptic disorders, diarrhea. Simultaneous systematic use of ketoconazole, cyclosporine, itraconazole or tacrolimus is contraindicated. It was also reported on the interaction of the drug with dronedarone and amiodarone.

Reception of dabigatran should be suspended 2 days before the planned operation, and if the clearance of the drug is reduced due to renal failure, 3-4 days. There is no specific antidote. If the patient switches from warfarin to dabigatran, the reception of the latter should be started with an MHO of less than 2.0.