Cardiology  |  Atrial Fibrillation Pathway - Other anticoagulant options




Cardiology

Atrial Fibrillation Pathway - Other anticoagulant options

  • Dabigatran was licensed for use in New Zealand July 2011 for stroke prevention in patients with non-valvular atrial fibrillation and  prevention of thromboembolism post major orthopaedic surgery.

  • If a patient taking warfarin has stable INR measurements and good venous access, then there is no clinical indication to switch to dabigatran.

Pradaxacap datasheet

Dabigatran Key concepts

  • For the prevention of stroke in people with non-valvular atrial fibrillation the recommended dose of dabigatran is:2

  • 150 mg, twice daily, for patients with a creatinine clearance >50 mL/min*

  • 110 mg, twice daily, for patients aged ≥ 80 years (because of the likelihood of an age-related decline in renal function).

  • Compliance with twice daily dosing is important as poor adherence may compromise the efficacy of dabigatran.

  • Dabigatran is predominantly renally excreted, so patients must have creatinine clearance >30 mL/min. It should be used cautiously in patients with creatinine clearance between 30 - 50 mL/min. Older patients with normal serum creatinine may have low creatinine clearance.

  • Potential adverse effects include bleeding, dyspepsia and gastrointestinal haemorrhage. The risk of myocardial infection also appears to be increased compared with patients taking warfarin.

  • Potential interactions may occur with aspirin, clopidogrel, NSAIDs, ketoconazole and St John's wort.

  • No specific monitoring test is available for anticoagulant effect and routine monitoring is not required. Creatinine clearance (or eGFR) should, however, be reassessed during long term use.

  • No reversal agent is available.

  • Dabigatran capsules are not able to be re-packaged into blister packs due light sensitivity.

  • As with every medicine it is appropriate to discuss with the patient the potential benefits and risks of dabigatran use prior to commencing treatment.

 

 



Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016


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