Dabigatran (Orthopaedic VTE Prophylaxis)

How it works

It is a prodrug converted to dabigatran, which directly and reversibly inhibits thrombin (factor IIa), preventing conversion of fibrinogen to fibrin and thrombus formation.

Prescribing in practice

• Bleeding is the principal risk — it is contraindicated in active clinically significant bleeding and severe renal impairment, and renal function must be assessed before and during use because clearance is largely renal.
• Idarucizumab is a specific reversal agent for emergency bleeding or urgent surgery, and concomitant strong P-glycoprotein inhibitors or other antithrombotics substantially increase bleeding risk.
• Capsules must not be removed from the blister or crushed as this raises absorption and bleeding risk, and dosing/frequency follow the surgical prophylaxis schedule in the SPC with the first dose timed after haemostasis.

Monitoring

Routine coagulation monitoring is not required, but check renal function periodically and before procedures and observe for signs of bleeding.

Counselling the patient

• Report unusual bruising, bleeding that will not stop, black stools or blood in urine.
• Swallow the capsule whole and keep it in its original blister pack until use; do not crush or open it.
• Tell any clinician or dentist you take an anticoagulant before procedures.

Evidence & guidelines

Dabigatran for VTE prophylaxis after major orthopaedic surgery is supported by the RE-MODEL and RE-NOVATE trial programme and is included in NICE VTE prevention guidance.