Should dabigatran replace warfarin for stroke prevention in AF?

Dabigatran etexilate (Pradaxa - Boehringer Ingelheim) is an oral anticoagulant that has been licensed in the EU since 2008 for thromboprophylaxis in adults following a hip or knee joint replacement. The marketing authorisation for the drug in the EU has recently been extended to include the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (AF). In theory, dabigatran could offer an advantage to patients who need anticoagulation because, unlike warfarin, its dose does not need to be individually adjusted and its effects do not require regular monitoring through blood sampling. Here we review the evidence for dabigatran in this new indication and consider its place in the management of patients with AF.