Treatment of venous thromboembolism with dabigatran
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PURPOSE OF REVIEW: The first study on the treatment of venous thromboembolism (VTE) with dabigatran (RE-COVER) was published in 2009. Three additional phase III trials on acute VTE therapy and extended treatment were recently presented. This article reviews the data and, where applicable, compares them with other novel oral anticoagulants, particularly rivaroxaban, for which all phase III trials have been published. RECENT FINDINGS: A twin study to RE-COVER (RE-COVER II) confirmed that dabigatran is not inferior to warfarin regarding efficacy and confers a lower risk for clinically relevant bleeding in the treatment of acute VTE for 6 months. Two studies on the extended treatment of VTE with dabigatran showed that the results for efficacy and safety can be extrapolated to another 16 months (mean) of treatment (RE-MEDY) and that dabigatran reduces the risk of recurrence by 90% compared with placebo (RE-SONATE). In the latter case, there is an increase of the risk for clinically relevant bleeding. SUMMARY: Dabigatran offers an alternative to warfarin for treatment of VTE without a need for coagulation monitoring or dose adjustments. Management of patients with VTE could thereby be simplified. Extended treatment might be considered more often for patients at higher risk of recurrence.
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