Dahl Ola E, Huisman Menno V
Department of Orthopaedics, Elverum Central Hospital, Elverum, Norway.
Expert Rev Cardiovasc Ther. 2010 Jun;8(6):771-4. doi: 10.1586/erc.10.67.
Schulman S, Kearon C, Kakkar AK et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N. Engl. J. Med. 361, 2342-2352 (2009). Venous thromboembolism (VTE) is associated with significant morbidity and mortality. The need for anticoagulation therapy is well recognized, but treatment is frequently suboptimal owing to limitations of current agents. The RE-COVER trial compared 150 mg twice-daily dabigatran etexilate (herafter referred to as dabigatran) with warfarin for 6 months in patients with acute VTE; dabigatran was as effective as warfarin in preventing recurrent VTE, with comparable major bleeding and significantly lower total bleeding rates. The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial on stroke prevention in patients with atrial fibrillation has also been completed recently, and dabigatran at higher doses showed superior efficacy in preventing stroke and systemic embolism, with lower bleeding than warfarin. Dabigatran provides convenient fixed-dose treatment without the need for monitoring, and has the potential to change the management of venous and arterial thromboembolism.
舒尔曼（Schulman）S、凯伦（Kearon）C、卡卡卡尔（Kakkar）AK等人。达比加群与华法林治疗急性静脉血栓栓塞症的比较。《新英格兰医学杂志》361卷，2342 - 2352页（2009年）。静脉血栓栓塞症（VTE）与显著的发病率和死亡率相关。抗凝治疗的必要性已得到充分认识，但由于现有药物的局限性，治疗往往未达到最佳效果。RE - COVER试验在急性VTE患者中，将每日两次服用150毫克达比加群酯（以下简称达比加群）与华法林进行了6个月的比较；达比加群在预防复发性VTE方面与华法林效果相当，主要出血发生率相当，但总出血率显著更低。近期还完成了关于房颤患者预防中风的长期抗凝治疗随机评估（RE - LY）试验，更高剂量的达比加群在预防中风和全身性栓塞方面显示出更优疗效，且出血情况低于华法林。达比加群提供方便的固定剂量治疗，无需监测，并且有可能改变静脉和动脉血栓栓塞症的治疗管理。
