Dabigatran ÎDabigatran is a selective, reversible, oral, direct thrombin inhibitor.
ÎIn the Randomized Evaluation of Long-term Anticoagulant Therapy (RE-LY) trial, annual rates of ischemic stroke or embolism were 1.69% with warfarin, 1.53% with 110 mg dabigatran bid (noninferior), and 1.11% with 150 mg dabigatran. The annual incidence of major bleeding was similar with warfarin and with 150 mg dabigatran but significantly less with 110 mg dabigatran. A striking result was the reduced frequency of hemorrhagic stroke with dabigatran compared with warfarin regardless of dabigatran dose.
ÎDabigatran does not require repeated measurement of drug effect.
ÎAfter stopping dabigatran, its half-life suggests that drug levels and drug effects should decrease by about 50% at 12-18 h and the trough levels to 25% of their previous steady state by 24 h.
ÎDabigatran has no antidote, and the management of life-threatening bleeding remains empirical.
Rivaroxaban ÎRivaroxaban is a direct factor Xa inhibitor
ÎIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) annual rates of ischemic stroke or systemic embolism were 1.7% with warfarin and 2.2% with 20 mg once daily rivaroxaban. The annual incidence of major bleeding was similar with warfarin and rivaroxaban, but the incidence of intracranial bleeding was significantly reduced with rivaroxaban compared with warfarin.
ÎRivaroxaban may be administered without the need for routine laboratory monitoring or dose adjustments.
ÎThere is currently no specific antidote available to antagonize the effects of rivaroxaban.
