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Stroke prevention in atrial fibrillation (AF)

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Atrial fibrillation (AF) is the most common cardiac rhythm disorder worldwide,1 with numbers expected to rise dramatically in the coming years.2,3 AF increases the risk of cardioembolic stroke five-fold4 and it is estimated that approximately 1 in 5 ischaemic strokes occur as a result of atrial fibrillation.5

Strokes relating to atrial fibrillation tend to be severe, leading to an increased likelihood of death and disability.6 Each year three million patients suffer AF-related strokes,5,7 with 92 percent being classified as ischaemic.8

Atrial fibrillation poses a significant negative impact on patients’ quality-of-life. Their emotional wellbeing, mental health and social functioning may be more negatively affected compared to people with other cardiac conditions.9

Guidelines

NOACs first choice treatment

Anticoagulation treatment options include vitamin K antagonists (VKAs, such as warfarin) and non-vitamin K oral anti-coagulants (NOACs, such as dabigatran etexilate). VKAs have been around for more than 50 years, but a range of limitations make them challenging to use.5

NOACs are a newer class of drug developed for the prevention of stroke in patients with non-valvular atrial fibrillation (SPAF).
Benefits of NOACs include:10 

  • Predictable action, not affected by diet
  • Do not need blood monitoring
  • Do not need frequent dose adjustment
  • Less drug-drug interactions than VKAs
  • Rapid onset and offset of action (particularly important for surgical procedures)

Latest guidelines from the European Society of Cardiology highlight the better efficacy, safety and convenience of the NOACs in comparison to oral anticoagulation with VKAs and state that when oral anticoagulant therapy is recommended NOACs should be considered in preference to VKAs.4

Dabigatran: confidence beyond clinical trials

Dabigatran etexilate was the first NOAC to be approved for stroke prevention in non-valvular atrial fibrillation (SPAF).11

When choosing an oral anticoagulant for your patients, it is important to look beyond clinical trials at the results of real-world data. With dabigatran, the results you read about are those that you may see in your own practice.11-21

  • >250,000 patients reviewed in the real-world12-18
  • Most robust, independent external reviews vs. warfarin12-18
  • Confirmation of positive benefit-risk profile by FDA12

Find out more

Please visit our website for more information on the use of dabigatran for the prevention of stroke in patients with atrial fibrillation (SPAF), including its safety, efficacy, dosing and administration.

 

References

  1. Lloyd-Jones DM, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004;110(9):1042-6.
  2. Chugh SS, et al. Worldwide epidemiology of atrial fibrillation. A global burden of disease 2010 study. Circulation. 2014;129:837-847.
  3. Rahman F, Kwan GF, Benjamin EJ. Global epidemiology of atrial fibrillation. Nat Rev Cardiol. 2014;11:639-654.
  4. Camm AJ, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. Eur Heart J. 2012;33:2719-2747.
  5. Camm AJ, et al. Guidelines for the management of atrial fibrillation. Eur Heart J. 2010;31(19):2369–429.
  6. Gladstone DJ, et al. Potentially Preventable Strokes in High-Risk Patients With Atrial Fibrillation Who Are Not Adequately Anticoagulated. Stroke. 2009;40(1):235-40.
  7. Atlas of Heart Disease and Stroke, World Health Organization, September 2004. http://www.who.int/cardiovascular_diseases/en/cvd_atlas_15_burden_stroke.pdf.
  8. Andersen KK. et al. Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke. 2009;40(6):2068-72.
  9. Dorian P., et al. The impairment of health-related quality of life in patients with intermittent atrial fibrillation: implications for the assessment of investigational therapy. J Am Coll Cardiol. 2000;36(4):1303-9.
  10. Cheng JW, Barillari G. Non-vitamin K antagonist oral anticoagulants in cardiovascular disease management: evidence and unanswered questions. J Clin Pharm Ther. 2014;39:118-135.
  11. Pradaxa European Summary of Product Characteristics 2015. Boehringer Ingelheim.
  12. Graham DJ, et al. Cardiovascular, bleeding, and mortality risks in elderly Medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation. Circulation. 2015;131:157-164.
  13. Seeger JD, et al. Safety and Effectiveness of Dabigatran and Warfarin in Routine Care of Patients with Atrial Fibrillation. Presented at AHA 2014.
  14. Villines TC, et al. A Comparison of the Safety and Effectiveness of Dabigatran and Warfarin in Nonvalvular Atrial Fibrillation Patients Enrolled in a Large Healthcare System. Presented at AHA 2014.
  15. Larsen TB, et al. Bleeding events among new starters and switchers to dabigatran compared with warfarin in atrial fibrillation. Am J Med. 2014;127:650-656.
  16. Larsen TB, et al. Myocardial ischemic events in 'real world' patients with atrial fibrillation treated with dabigatran or warfarin. Am J Med. 2014;127:329-336.
  17. Lauffenburger JC, et al. Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study. J Am Heart Assoc. 2015;4:e001798.
  18. Abraham NS, et al. Comparative risk of gastrointestinal bleeding with dabigatran, rivaroxaban, and warfarin: population based cohort study. BMJ. 2015;350:h1857.
  19. Connolly SJ, et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-1151.
  20. Connolly SJ, et al. Newly identified events in the RE-LY trial. N Engl J Med 2010;363(19):1875-1876 (appendix).
  21. Connolly SJ, et al. Additional events in the RE-LY trial. N Engl J Med 2014;371(15):1464-1465.