Dabigatran: ready for prime time?

Studies in high-risk surgical patients have demonstrated the efficacy of the selective inhibitors of factor Xa and thrombin in preventing venous thromboembolism. Because of their predictable dose-response, which eliminates the need for routine laboratory monitoring, they may be more convenient for patients requiring long-term therapy, and have the potential to improve the quality of anticoagulation. The results from 2 large trials of dabigatran (a thrombin inhibitor) compared to warfarin, in patients with atrial fibrillation and those with acute symptomatic venous thromboembolism, have recently become available. These trials provide convincing evidence of the efficacy of dabigatran in preventing patient-important clinical outcomes when compared to warfarin. In this paper we critically review these trials and discuss the feasibility of replacing warfarin with dabigatran for these indications.