Date of Award

2013

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Dabigatran is superior to Warfarin in patients with atrial fibrillation.

STUDY DESIGN: Review of three English language primary studies published in 2007, 2009, and 2010.

DATA SOURCES: Three randomized control trials found using Cochrane Database.

OUTCOME(S) MEASURED: Outcomes measured were presence or absence of stroke or systolic embolism and intracranial hemorrhage. The absence of these events preserved neurologic function in patients with atrial fibrillation.

RESULTS: In both VKA-naïve and VKA-experienced patients, Dabigatran 150 mg was superior to Warfarin in both the prevention of stroke and systolic embolism and the prevention of intracranial hemorrhage. Thromboembolic events were most common in the group receiving Dabigatran 50 mg alone. When comparing Dabigatran and Warfarin without including previous VKA status, Dabigatran 150 mg is superior to Warfarin in prevention of stroke and systolic embolism, while Dabigatran 110 mg is noninferior. Hemorrhagic stroke rates were similar in both dose groups.

CONCLUSIONS: It is concluded that Dabigatran is superior to Warfarin in 150 mg dose and noninferior to Warfarin in 110 mg dose. Further research is warranted to determine other indications for treatment with Dabigatran.

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