dabigatranu

Dabigatran, known in some contexts as dabigatran or dabigatranu, is an oral direct thrombin inhibitor used as an anticoagulant. It is indicated to reduce the risk of stroke and systemic embolism in nonvalvular atrial fibrillation and is also used for prophylaxis of venous thromboembolism after hip or knee replacement in certain guidelines. It is not approved for use in patients with mechanical heart valves due to an increased risk of adverse outcomes.

The drug acts by directly inhibiting thrombin (factor IIa), thereby preventing the conversion of fibrinogen to fibrin and reducing clot formation. By targeting thrombin, it affects both circulating and clot-bound thrombin, contributing to its anticoagulant effect.

Dabigatran is administered as a prodrug, dabigatran etexilate, which is converted to active dabigatran after absorption. It has relatively low oral bioavailability and is a substrate of P-glycoprotein, with absorption influenced by renal function and age. The drug is primarily eliminated by the kidneys, and its half-life lengthens in the elderly or in people with reduced renal function. Routine coagulation monitoring is not required, but renal function should be assessed regularly, and dosing may need adjustment based on creatinine clearance.

Safety considerations include an increased risk of bleeding, particularly in the elderly, those with renal impairment, or when used with other anticoagulants or antiplatelet agents. Potential drug interactions involve P-glycoprotein inhibitors and inducers. Contraindications include active major bleeding, severe renal impairment, pregnancy, and known hypersensitivity. Reversal of dabigatran in cases of serious bleeding or emergency procedures is achieved with the monoclonal antibody idarucizumab.