Dabigatran

• MOA
  • Direct reversible thrombin inhibitor (factor 2a)
  • Prevents conversion of fibrinogen to fibrin
• Surgery
  • Stop 2 days before surgery and 3 if renal failure
• Monitor
  • Thrombin time
    • Highly sensitive to dabigatran. A normal TT suggests minimal drug effect, but a prolonged TT does not correlate directly with drug levels.
  • aPTT
    • Provides a rough estimate of dabigatran’s effect. Prolonged aPTT suggests anticoagulation, but the relationship is nonlinear at higher drug concentrations
  • Dilute TcT
    • A specialised assay specifically designed to measure dabigatran levels.
• Reversal
  • Monoclonal antibody
  • Praxbind (Idarucizumab)
• Dose
  • 150mg BD if >50 CrCL
  • 110mg BD if 30-50 CrCL
• Considerations
  • Renal excreted
  • Takes longer to washout in renal impairment
  • Only reversal agent is Praxbind (Idarucizumab) - works instantly
• Perioperative management
  • CrCL >50 - withhold for 48hrs prior to day of surgery
  • CrCL 30-50 - withhold for 4-5 days prior to day of surgery
• Resumption
  • 24 hours after surgery if low bleeding risk
  • 48-72 hours after surgery if high risk bleeding