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Several alternatives to warfarin for prevention of venous thromboembolism and stroke are already approved for clinical use, and several more are in development. The principal advantage of these agents is their ease of use. Yet they also have known disadvantages — such as the lack of a rapid reversal agent and cost — and, possibly, unknown toxicities. By contrast, warfarin has been in use for millions of patient-years, and its effects (both beneficial and adverse) are very familiar.
Dabigatran was FDA-approved for treatment of atrial fibrillation after the landmark RE-LY study (JW Cardiol Sep 1 2009). A secondary finding from RE-LY showed a significant increase in myocardial infarction with dabigatran. To find out more, investigators conducte…