The PROTECT-AF (WATCHMAN Left similar to the 33% relative reduction in stroke achieved with dabigatran 150 mg bid compared with VKA therapy (Table 9).84 Therefore, any advan- tages of dabigatran with respect to thromboembo- lism would likely not exist for motivated patients who are able to participate in home monitoring of their VKA therapy. Although home monitoring will reduce the burden of INR testing and VKA dose adjustment, the burdens of VKA therapy related to dietary restrictions and drug interactions will still exist, and there will be a cost for the home monitoring device and test strips. Therefore, depend- ing on how patients value these burdens, some may choose dabigatran rather than home monitoring of VKA therapy. Before prescribing dabigatran, clinicians need to judge whether the patient is similar enough to those enrolled in RE-LY that the clinical trial results are still likely to apply. In particular, the RE-LY study excluded patients with severe renal impairment (estimated creatinine clearance 30 mL/min or less).84 The cost-effectiveness of the new anticoagulants compared with VKA therapy is another consider- ation. An economic analysis based on pricing of dabigatran in the United Kingdom (US $13 per day) estimated that dabigatran 150 mg bid would cost $45,372 more per quality-adjusted life year gained compared with warfarin for patients with AF aged 65 years with risk factors for stroke (CHADS2 score of 1). The cost-effectiveness estimates in this model were sensitive to the pricing of dabigatran.93 Recommendation 2.1.11. For patients with AF, including those with paroxysmal AF, for recommendations in favor of oral anticoagulation (including 2.1.9, gest dabigatran 150 mg twice daily rather than adjusted-dose VKA therapy (target INR range, 2.0-3.0) (Grade 2B). Remarks: Dabigatran is excreted primarily by the kidney. 