Direct thrombin (factor IIa) inhibitor (DOAC)
Dabigatran etexilate
Brand names: Pradaxa
Adult dose
Dose: NVAF/VTE: 150mg BD (110mg BD ≥80y, verapamil, bleeding risk); VTE prophylaxis post-orthopaedic: 220mg OD
Route: Oral
Frequency: BD
Clinical pearls
- NICE NG196 AF / NICE NG158 VTE — DOAC first-line
- Reversal: idarumab (Praxbind) — specific antidote
- BSH guidance on DOAC monitoring and perioperative use
Contraindications
- CrCl <30
- Active major bleeding
- Mechanical heart valves
- Antiphospholipid syndrome (triple-positive)
- Severe hepatic disease
- Hypersensitivity
Side effects
- Bleeding (GI, intracranial)
- Dyspepsia
- Hepatic dysfunction
Interactions
- P-gp inhibitors (verapamil, amiodarone, dronedarone — dose adjust or avoid)
- P-gp inducers (rifampicin)
- Antiplatelets/NSAIDs
Monitoring
- FBC
- Renal function (baseline + annually; more often if CrCl 30–60)
- LFTs
- Bleeding
Reference: BNF; NICE NG196; NICE NG158; BSH; ESC AF guidelines; https://bnf.nice.org.uk/drugs/dabigatran-etexilate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Same class
- ABC-Bleeding Score for Anticoagulated Atrial Fibrillation · Bleeding Risk
- GARFIELD-AF Risk Score for Atrial Fibrillation · Atrial Fibrillation
- DOAC Score for Selecting Direct Oral Anticoagulant in Non-Valvular AF · Anticoagulation
- ORBIT Bleeding Risk Score for Anticoagulation in AF Patients · Anticoagulation
Pathways
Same specialty