Dabigatran Etexilate

How it works

The prodrug is converted to dabigatran, which directly and reversibly inhibits free and clot-bound thrombin (factor IIa), preventing conversion of fibrinogen to fibrin and thrombus formation.

Prescribing in practice

• Bleeding is the principal hazard; assess renal function and bleeding risk before and during treatment, as clearance is substantially renal and it is contraindicated in severe renal impairment.
• A specific reversal agent, idarucizumab, is available for life-threatening bleeding or urgent surgery.
• Capsules must be swallowed whole and kept in the original packaging because of moisture sensitivity; absorption is reduced if the pellets are removed from the capsule.

Monitoring

Routine coagulation monitoring is not required, but assess renal function periodically and watch for bleeding.

Counselling the patient

• Report unusual bruising or any bleeding that does not stop, and black or bloody stools.
• Swallow the capsule whole with water and keep capsules in their original blister or bottle.
• Tell any dentist, surgeon or pharmacist that you take an anticoagulant before procedures or new medicines.

Evidence & guidelines

The RE-LY trial established dabigatran for stroke prevention in atrial fibrillation, and it is recommended by NICE for this and for venous thromboembolism.