The new blood-thinner dabigatran is shown to protect against stroke, blood clotting and major bleeding as effectively as the currently widely used Coumadin® (warfarin), but with fewer side effects, according to an article reviewed by F1000 Medicine Faculty Members Robert Ruff, Brian Olshansky and Luis Ruilope.

The original paper, Dabigatran versus warfarin in patients with atrial fibrillation, by Neal Devaraj and Stuart Connolly et al. in the New England Journal of Medicine, says warfarin (also commonly used in rat poison) has several drawbacks. Finding the correct dosage requires careful and laborious monitoring, and the risk of major bleeding has led to it being under-used.

With fewer side-effects and complications than warfarin, the reviewers see many potential benefits from dabigatran. According to Olshansky, it is “perhaps one of the important drug discoveries in the past decade.” Dabigatran may become an alternative to Coumadin.

Ruilope says that according to the investigators, “This oral anticoagulant prevents strokes and peripheral embolic events in patients with atrial fibrillation significantly better than that much older drug (warfarin) at different doses. It is also safer than warfarin with respect to major bleeding events.”

“An immediate change of practice is not warranted but a change in standard anticoagulant therapy may be needed,” Ruilope says (Courtesy of EurekAlert!, a service of AAAS).

The full text of this article is available free for 90 days at

Dabigatran versus warfarin – Coumadin® – for atrial fibrillation

Editorial note – Unlike Coumadin®, the new medication dabigatran does not work by inhibition of vitamin K activity in the body, which is good news. There have been concerns that chronic inhibition of vitamin K activity in the body may contribute to other health problems over time, such as calcification of arteries – Dr. Z.