Dabigatran (Stroke Prevention — AF)

How it works

Its active moiety is a reversible direct thrombin (factor IIa) inhibitor, preventing fibrin formation and thrombin-mediated platelet activation.

Prescribing in practice

• It is substantially renally cleared and contraindicated in severe renal impairment, so renal function must be assessed before starting and the patient reassessed if function declines, given the bleeding risk of accumulation.
• A specific reversal agent, idarucizumab, is available for emergency reversal in life-threatening bleeding or urgent surgery.
• Capsules must not be removed from the blister or pill organiser until use and must be swallowed whole, as moisture exposure and opening the capsule markedly affect bioavailability.

Monitoring

Routine coagulation monitoring is not required, but check renal function at least annually and more often in renal impairment, the elderly or intercurrent illness.

Counselling the patient

• Swallow capsules whole and keep them in the original packaging until taken.
• Report bleeding, black stools, unusual bruising or significant falls.
• Carry an anticoagulant alert card and inform clinicians before any procedure.

Evidence & guidelines

The RE-LY trial established dabigatran as effective for stroke prevention in atrial fibrillation compared with warfarin, supporting its NICE-recommended use.