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An audit of dabigatran etexilate prescribing in Victoria

To the Editor: In 2009, the RE-LY (Randomized Evaluation of Long-Term Anticoagulant Therapy) trial compared dabigatran etexilate with warfarin for prevention of stroke and systemic embolism in 18 113 patients with non-valvular atrial fibrillation (AF) and at least one additional risk factor for stroke.1 In April 2011, it became accessible in Australia (Pradaxa; Boehringer Ingelheim) under a product familiarisation program funded by the manufacturer; however, the Pharmaceutical Benefits Advisory Committee expressed concern that without informed and appropriate prescription, clinical trial outcomes may not be reproducible.2 Case reports from Europe3 and New Zealand4 identified the need for caution when treating older patients, those with low body weight or patients with renal impairment because of the risk of serious bleeding.

We performed a retrospective audit of the available criteria of indication, renal function and time in therapeutic range (TTR) of 362 patients at a private anticoagulant clinic who were transferred from warfarin to dabigatran between 1 June 2011 to 30 November 2011. Patients recorded as having AF were presumed to have non-valvular…