Dabigatran
Dabigatran
Dabigatran is an oral anticoagulant that works by being a direct thrombin inhibitor. It is one of the drugs developed over the past 20 years as an alternative to warfarin, with the advantage that it does not require regular monitoring.What is dabigatran used for?
Dabigatran is currently used for two main indications.
Firstly it is an option in the prophylaxis of venous thromboembolism following hip or knee replacement surgery.
Secondly, it is also licensed in the UK for prevention of stroke in patients with non-valvular atrial fibrillation who have one or more of the following risk factors present:
- previous stroke, transient ischaemic attack or systemic embolism
- left ventricular ejection fraction below 40%
- symptomatic heart failure of New York Heart Association (NYHA) class 2 or above
- age 75 years or older
- age 65 years or older with one of the following: diabetes mellitus, coronary artery disease or hypertension
What are the known side-effects of dabigatran?
Unsurprisingly haemorrhage is the major adverse effect.
Doses should be reduced in chronic kidney disease and dabigatran should not be prescribed if the creatinine clearance is < 30 ml/min.
Reversing the effects
Idarucizumab cab be used for rapid reversal of the anticoagulant effects of dabigatran.
Drug Safety Update 2013
The RE-ALIGN study showed significantly higher bleeding and thrombotic events in patients with recent mechanical heart valve replacement using dabigatran compared with warfarin.
Previously there had been no guidance to support the use of dabigatran in patients with prosthetic heart valves but the advice has now changed to dabigatran being contraindicated in such patients.
+PassMedicine Notes
Dabigatran is an oral anticoagulant that works by being a direct thrombin inhibitor. It is one of the drugs developed over the past 20 years as an alternative to warfarin, with the advantage that it does not require regular monitoring.
What is dabigatran used for?
Dabigatran is currently used for two main indications.
Firstly it is an option in the prophylaxis of venous thromboembolism following hip or knee replacement surgery.
Secondly, it is also licensed in the UK for prevention of stroke in patients with non-valvular atrial fibrillation who have one or more of the following risk factors present:- previous stroke, transient ischaemic attack or systemic embolism
- left ventricular ejection fraction below 40%
- symptomatic heart failure of New York Heart Association (NYHA) class 2 or above
- age 75 years or older
- age 65 years or older with one of the following: diabetes mellitus, coronary artery disease or hypertension
What are the known side-effects of dabigatran?
Unsurprisingly haemorrhage is the major adverse effect.
Doses should be reduced in chronic kidney disease and dabigatran should not be prescribed if the creatinine clearance is < 30 ml/min.
Reversing the effects
Idarucizumab cab be used for rapid reversal of the anticoagulant effects of dabigatran.
Drug Safety Update 2013
The RE-ALIGN study showed significantly higher bleeding and thrombotic events in patients with recent mechanical heart valve replacement using dabigatran compared with warfarin.
Previously there had been no guidance to support the use of dabigatran in patients with prosthetic heart valves but the advice has now changed to dabigatran being contraindicated in such patients.