Dabigatran etexilate: An alternative to warfarin for patients with nonvalvular atrial fibrillation.

PURPOSE: To critically appraise the evidence on dabigatran etexilate, Pradaxa, as an alternative to warfarin for stroke prevention among patients with nonvalvular atrial fibrillation. This information can assist nurse practitioners in making informed treatment decisions. DATA SOURCES: A review of the literature was conducted using CINAHL and PubMed databases. Reports published on cardiovascular organizational web sites were also searched, along with reference lists of relevant published articles and reports.
CONCLUSIONS: Significant evidence from the PETRO and RE-LY trials and postmarketing analyses of dabigatran etexilate indicate that this direct thrombin inhibitor is as efficacious as warfarin in ischemic stroke prevention. In fact, the studies found that patients taking dabigatran etexilate had fewer incidences of ischemic stroke and intracranial hemorrhage than those taking warfarin. Risk for major gastrointestinal bleeding appears to be higher than that for warfarin. IMPLICATIONS FOR PRACTICE: Patients taking dabigatran etexilate do not require blood work to assess international normalized ratio (INR) levels. Because this drug is excreted primarily by the kidneys, reassessment of renal function is critical during treatment, especially with concomitant use of diuretics, fluctuating renal function, or hypovolemia. As with warfarin, nurse practitioners should educate patients about when to seek immediate care for the development of anticoagulant-associated bleeding.