Department of Neurology and Stroke Unit, University of Duisburg - Essen, Hufelandstrasse 55, 45147, Essen, Germany.
Curr Neurol Neurosci Rep. 2012 Feb;12(1):17-23. doi: 10.1007/s11910-011-0229-4.
Dabigatran is a direct inhibitor of thrombin that has recently been approved for primary and secondary stroke prevention and prevention of systemic embolism in patients with atrial fibrillation. The RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy [with Dabigatran Etexilate]) study showed that dabigatran given at a dose of 110 mg twice a day (bid) was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin (International Normalized Ratio target 2.0-3.0), and lower rates of major hemorrhage. Dabigatran administered at a dose of 150 mg bid was significantly more effective compared with warfarin and showed a similar rate of major hemorrhages. Both dosages resulted in an approximately 60% to 70% relative reduction of intracranial hemorrhage. The dosage of 110 mg bid should be preferably used in patients older than 75 years at a higher bleeding risk. The Hemoclot (Hyphen BioMed, Mason, OH) test to measure dabigatran serum concentration is commercially available, but presence of the drug may also be detected using the activated partial thromboplastin time or thrombin time.
达比加群酯是一种直接凝血酶抑制剂，最近已被批准用于房颤患者的首发和二级卒中和全身性栓塞预防。RE-LY（随机评价长期抗凝治疗[达比加群酯]）研究表明，达比加群酯以 110mg 每日两次（bid）的剂量给药与华法林（国际标准化比值目标 2.0-3.0）相关的卒中及全身性栓塞发生率相似，且大出血发生率较低。达比加群酯以 150mg bid 的剂量给药与华法林相比更为有效，且主要出血的发生率相似。两种剂量均可使颅内出血的相对发生率降低约 60%至 70%。对于出血风险较高的 75 岁以上患者，应优选使用 110mg bid 的剂量。达比加群酯的血清浓度检测可用 Hemoclot（Hyphen BioMed，Mason，OH）检测，但也可使用活化部分凝血活酶时间或凝血酶时间检测到该药物的存在。
