• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home The Classics General Medicine Classics

The RE-LY trial: Dabigatran non-inferior to warfarin in preventing strokes in patients with atrial fibrillation [Classics Series]

bys25qthea
February 21, 2014
in General Medicine Classics, The Classics
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

Image: CC/L. academia

1. High-dose dabigatran is superior to warfarin in the prevention of strokes in patients with atrial fibrillation, while low-dose dabigatran is non-inferior to warfarin in preventing strokes in this population

2. There is lower risk of major hemorrhage on low-dose dabigatran compared to warfarin, while there is similar rate of major hemorrhage on high-dose dabigatran as compared to warfarin

Original Date of Publication: September 17, 2009

Study Rundown: Dabigatran is non-inferior to warfarin in the prevention of stroke in at-risk patients with atrial fibrillation, and is associated with an overall lower risk of major bleeding and intracranial hemorrhage. For those at-risk patients requiring anticoagulation for the prevention of stroke in the context of atrial fibrillation, dabigatran could be considered as an alternative to warfarin in those patients with a creatinine clearance >30ml/min, as dabigatran is renally cleared. A major criticism of the RE-LY trial is the high risk of bias created by the unblinded administration of warfarin. Moreover, it has been noted that the incidence of intracranial hemorrhage with warfarin observed in this study was much higher than previously reported rates and reasons for this are unclear.

Please click to read the study in NEJM

Primer: Anticoaguation with warfarin, a vitamin K antagonist, has long been the standard of care for preventing thromboembolic strokes in high-risk patients with atrial fibrillation. Warfarin, however, is limited by the need for frequent monitoring due to its narrow therapeutic window, as well as its variable pharmacokinetics and drug interactions. Furthermore, its use is associated with a significant risk of major bleeding.

RELATED REPORTS

Stroke may be associated with sleep disturbances in adults

Transcarotid artery revascularization not associated with a significant difference in 30-day risk of stroke, death and myocardial infarction compared to carotid endarterectomy

Synergistic interaction between risk burden and genetics for atrial fibrillation development

Dabigatran, a direct thrombin inhibitor, is one of the new oral anticoagulants introduced within the last decade as a possible alternative to warfarin. There is evidence for its use for venous thromboembolism (VTE) prophylaxis after total knee or hip arthroplasty, as well as in the treatment of acute VTE. No evidence, however, existed for the use of dabgitran in the context of atrial fibrillation in the prevention of stroke.

The RE-LY trial was published in the New England Journal of Medicine in 2009. In the era of the new anticoagulants, this landmark RCT compared low- (110 mg PO BID) and high-dose (150 mg PO BID) dabigatran with dose-adjusted warfarin in preventing stroke in at risk patients with atrial fibrillation. The risk of major bleeding on dabigatran as compared to warfarin was also investigated.

Relevant Reading:

  1. Wolowacz SE, Roskell NS, Plumb JM, et al. Efficacy and safety of dabigatran etexilate for the prevention of venous thromboembolism following total hip or knee arthroplasty: A meta-analysis. Thromb Haemost 2009;101(1):77-85.
  2. Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009;361:2342-2352.

In-Depth [randomized, controlled study]: This large, randomized, double-blinded, controlled trial included 18,113 patients from 951 clinical centers in 44 countries. Patients were randomized to 3 groups: 1) dose-adjusted warfarin titrated to INR of 2.0-3.0, 2) low-dose dabigatran (110 mg PO BID), or 3) high-dose dabigatran (150 mg PO BID). Notably, dabigatran administration was blinded, while warfarin administration was unblinded. The primary outcome studied was stroke or systemic embolism. The primary safety outcome was major hemorrhage. The trial lasted a total of 2 years.

Results revealed that the rate of stroke was significantly less in patients that received high-dose dabigatran as compared to warfarin, and there was no significant difference in major bleeding between these two groups. Furthermore, low-dose dabigatran was non-inferior to warfarin in preventing strokes, but it was associated with a significant reduction in risk of major bleeding. Intracranial hemorrhage was significantly less common in both dabigatran groups compared to warfarin. Rate of major gastrointestinal bleeding was significantly higher for patients receiving high-dose dabigatran as compared to the warfarin group. There was no significant difference in mortality between all three groups. Dyspepsia was the only adverse effect that was significantly more common with dabigatran.

By Aimee Li, M.D.; Andrew Cheung, M.D.

© 2012 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. DISCLAIMER: Posts are not medical advice and are not intended as such. Please see a healthcare professional if you seek medical advice.

Tags: atrial fibrillationdabigatranRE-LYRELYstrokewarfarin
Previous Post

Black men less likely to receive follow-up for elevated prostate cancer marker, PSA

Next Post

The AFFIRM trial: Rate-control vs. rhythm-control in atrial fibrillation [Classics Series]

RelatedReports

Sleep duration, sleepiness, chronotype have variable associations with teen self-regulation
Chronic Disease

Stroke may be associated with sleep disturbances in adults

March 25, 2023
Patient Basics: Thrombotic Stroke
Imaging and Intervention

Transcarotid artery revascularization not associated with a significant difference in 30-day risk of stroke, death and myocardial infarction compared to carotid endarterectomy

March 24, 2023
Rivaroxaban likely reduces risk of recurrent stroke in specific subgroup of patients with embolic stroke of undetermined source
Cardiology

Synergistic interaction between risk burden and genetics for atrial fibrillation development

March 21, 2023
Intensive rehabilitation not superior to traditional therapy for arm function after stroke
Weekly Rewinds

2 Minute Medicine Rewind March 20, 2023

March 20, 2023
Next Post
Classics Series, Landmark Trials in Medicine

The AFFIRM trial: Rate-control vs. rhythm-control in atrial fibrillation [Classics Series]

New clinical prediction model helps emergency physicians identify high-priority febrile children

New clinical prediction model helps emergency physicians identify high-priority febrile children

Frequent meals linked with lower body weight in children and adolescents

Frequent meals linked with lower body weight in children and adolescents

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Metformin use may decrease risk of osteoarthritis development
  • Intensive blood pressure lowering by non-physician healthcare providers significantly reduces the risk of cardiovascular disease
  • Expectant management of patent ductus arteriosus noninferior to early ibuprofen use
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options