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.
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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