Dabigatran: direct thrombin inhibitor

Creatinine Clearance (CrCl) > 30ml/min: 150mg twice daily
CrCl 15-30 ml/min: 75 mg twice daily
CrCl <15ml/min: do not use

Indication: Patients with non-valvular atrial fibrillation requiring anticoagulation
Suitable candidates for treatment: patients with unstable INRs, complicated drug regimens, high risk for intracranial bleeding, and difficulty in have INRs monitored regularly

Do not use for patients with the following:
• Severe renal impairment
• End stage renal disease on Hemodialysis (until more information is available)
• Mechanical heart valves
• Acute stroke (within 14 days or disabling stroke within 6 months)
• Infective endocarditis
• Acute liver disease (LFTs >2 times the upper limit of normal)
• Concomitant P-glycoprotein inducers (rifampin, St. Johns Wort, see drug drug interactions for more)
• Active pathologic bleed or GI bleeding within past year or recurrent GI bleed
• Pregnancy
• Inability to swallow capsules (capsules may not be opened or crushed)
• History of hypersensitivity reaction

For more information, including switching between anticoagulant regimens, drug-drug interactions, management with bleeding, and surgical considerations, please follow the link to the European Heart Rhythm Association’s Practical Guide on the use of new oral anticoagulants: http://eurheartj.oxfordjournals.org/content/early/2013/04/25/eurheartj.eht134