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Is there really misuse and abuse of dabigatran?

A brief commentary on the RE-LY study

Appropriate and optimal anticoagulation for the increasing number of Australians with non-valvular atrial fibrillation (AF) remains a challenge. If achieved, it would substantially reduce the burden of disabling and fatal AF-related stroke.

Four large randomised controlled trials (RCTs) have reported that the direct thrombin inhibitor, dabigatran etexilate, and the direct activated factor X (Xa) inhibitors, rivaroxaban and apixaban, are at least as efficacious and safe as warfarin, and apixaban is superior to aspirin, in a broad range of individuals with non-valvular AF.15 On the basis of these results, regulators have approved dabigatran in more than 75 countries, including Australia, and guidelines suggest that the new oral anticoagulants are preferable to warfarin for most patients with non-valvular AF.69

Patient selection in the RE-LY trial

The RE-LY (Randomized Evaluation of…