Dabigatran Cuts Bleeding Risk in VTE Prophylaxis : Rate 29% lower than with warfarin.

Results of the trial were published simultaneously in the New England Journal of Medicine (2009;361:2342–52[doi:10.1056/NEJMoa0906598]).

The study was sponsored by Boehringer Ingelheim. Dr. Shulman disclosed receiving honoraria from AstraZeneca, Bayer Healthcare, Boehringer Ingelheim, GlaxoSmithKline and Sanofi-Aventis, lecture fees from LeoPharma and Sanofi-Aventis, and an unrestricted grant from Bayer.

My Take

New Anticoagulants Hold Promise

Safer oral anticoagulants are needed, and this study highlights an emerging option for replacing warfarin.

However, this study design didn't address the important potential for new oral anticoagulants to meet both the acute and chronic anticoagulation indications for VTE. This study treated VTE acutely with traditional inpatient parenteral anticoagulants.

For hospitalists, the value in these new anticoagulants will be the potential to write a prescription for oral therapy straight from the emergency department, essentially turning uncomplicated acute VTE into an outpatient condition.

Hospitalists will be on the front lines in managing possible complications of new anticoagulants. Renally impaired patients were excluded from this study, yet patients on these medications might develop acute kidney injury and require hospitalization unexpectedly. How will we reverse this agent if needed? This will be uncharted territory for hospitalists.

FRANK MICHOTA, M.D., is the Director of Academic Affairs in the Department of Hospital Medicine at the Cleveland Clinic. He reports no relevant conflicts of interest.

DR. MICHOTA