dabigatraan

Dabigatran, commonly known by its brand name Pradaxa, is an oral direct thrombin inhibitor used as an anticoagulant. It is administered as a prodrug, dabigatran etexilate, which is converted in the body to the active dabigatran form. It is approved for reducing the risk of stroke and systemic embolism in nonvalvular atrial fibrillation and for prevention of venous thromboembolism after hip or knee replacement surgery.

Dabigatran works by directly inhibiting thrombin (factor IIa), thereby preventing the conversion of fibrinogen to fibrin and reducing clot formation. It belongs to the class of direct oral anticoagulants (DOACs). Pharmacokinetically, it has relatively low oral bioavailability and rapid absorption, with most of the drug eliminated unchanged by the kidneys. Hepatic metabolism is limited, and it is a substrate for P-glycoprotein transporters, which can influence its exposure when combined with certain drugs.

Dosing is typically fixed and not guided by routine coagulation testing. For nonvalvular atrial fibrillation, 150 mg twice daily is commonly used, with dose adjustments or avoidance in patients with reduced renal function or significant bleeding risk according to regional guidelines. Postoperative prophylaxis after hip or knee replacement follows indication-specific regimens. Because of renal excretion, kidney function strongly affects dosing and safety; caution is warranted in patients with reduced creatinine clearance. Dabigatran is not approved for patients with mechanical heart valves.

Safety considerations include an increased risk of bleeding, including serious and life-threatening events. It can cause dyspepsia and other gastrointestinal complaints. Reversal of anticoagulation is possible with idarucizumab, a targeted antidote, and, in some cases, hemodialysis can remove dabigatran. Spinal or epidural anesthesia carries a risk of hematoma. Avoid use with active major bleeding and consider drug interactions, especially with strong P-glycoprotein inhibitors or inducers.