Dabigatran vs warfarin

The direct-acting oral anticoagulant dabigatran (Pradaxa) causes fewer bleeding events as a result of over-anticoagulation than warfarin but may be more costly to manage with reversal agents, experience from New Zealand suggests.

A review of more than 550 hospital admissions for over-anticoagulation found that the admission rate was twice as high for warfarin patients than for those taking dabigatran (4.8 vs 2.4 admissions per 100 users).

The review of admissions at Auckland’s North Shore Hospital during 2015 showed that, while management of over-anticoagulation was usually straightforward, it could cost almost $5000 per episode for dabigatran when the reversal agent idarucizumab (Praxiband) was required.

It found that 35 patients had serious bleeding that required additional interventions, of whom 29 were warfarin patients and six were dabigatran.

For warfarin, the over-anticoagulation